Digoxin and Succinylcholine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Digoxin
Succinylcholine
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
An increased risk of cardiac arrhythmias
Interaction Deep Dive
Concomitant digoxin and succinylcholine therapy has been reported to result in cardiac arrhythmias3412. This interaction is presumably due to exacerbation of digitalis-induced ventricular irritability and effects on conduction, and/or shifts of potassium from inside muscle cells to the outside of the digitalized myocardium. An effect on cholinergic receptors resulting in release of catecholamines has also been postulated.
Why it happens (mechanism)
Exacerbation of digitalis-induced ventricular irritability and/or shifts of intracellular potassium
Literature reports
2 reports — tap to read
a) A digitalized 63-year-old female developed ventricular arrhythmias following repeated doses of succinylcholine. A total of 160 mg of succinylcholine had been administered when the patient developed ventricular fibrillation and cyanosis. After approximately 30 seconds, sinus rhythm returned. This patient had a history of myocardial infarction, and had also developed an atrial fibrillation following a calcium infusion test two days prior to the administration of succinylcholine 1.
b) The incidence of arrhythmias in digitalized patients who received either succinylcholine or pancuronium were compared. They divided 104 patients into four groups: Groups 1 and 2 were not receiving digitalis therapy, and Groups 3 and 4 were maintained on digoxin, diuretic therapy, and potassium supplementation. Patients in Groups 1 and 3 received succinylcholine 2 mg/kg while Groups 2 and 4 were administered pancuronium 0.12 mg/kg. Results showed that the incidence of dysrhythmias was significantly higher in the Group 4 patients who were receiving digoxin and pancuronium (6 out of 18 patients) than in Group 3, who received digoxin and succinylcholine (3 out of 46 patients). Additionally, there was no significant difference in the incidence of dysrhythmias following the administration of succinylcholine in digitalized or non-digitalized patients. The authors concluded that succinylcholine need not be withheld in patients on digitalis therapy, and that caution should be exercised when administering succinylcholine and pancuronium to digitalized patients 2.
Common questions
Can I take Digoxin and Succinylcholine together?
An increased risk of cardiac arrhythmias Always confirm with your pharmacist or prescriber before making any change.
How serious is the Digoxin and Succinylcholine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Digoxin or Succinylcholine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (4)
- Smith RB & Petruscak J: Succinylcholine, digitalis, and hypercalcemia: a case report. Anesth Analg 1972; 51:202-205. DOI
- Bartolone RS & Rao TLK: Dysrhythmias following muscle relaxant administration in patients receiving digitalis. Anesthesiology 1983; 58:567-569. PubMed
- Birch AA Jr, Mitchell GD, Playford GA, et al: Changes in serum potassium response to succinylcholine following trauma. JAMA 1969; 210:490-493. DOI
- Curran FJ, Smith WE, & Lauro S: Report of a severe case of tetanus managed with large doses of intramuscular succinylcholine. Anesth Analg 1968; 47:218-221.
Keep reading about Digoxin
Keep reading about Succinylcholine
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