Drug Interaction Report

Licorice and Digoxin: Interaction Details

A pharmacist-reviewed analysis of the Licorice and Digoxin interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Digoxin

Cardoxin® Digitek Digitek® Digox Lanoxicaps® Lanoxin Lanoxin®
+

Licorice

No brand names on record
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
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Interaction severity
Moderate
Can be significant — usually manageable with monitoring.
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.

Of 38 documented Licorice interactions, 33 are rated moderate — including this one.
Onset
delayed
Evidence
theoretical
Severity
Moderate

What happens

Increased risk of digoxin toxicity

Interaction Deep Dive

Symptoms of congestive heart failure and hypokalemia occurred in a patient taking licorice, furosemide, and digoxin1. Licorice alone has been reported to be the likely cause of hypokalemia, hypertension, and torsades de pointes 234567. Hypokalemic paralysis has also resulted from licorice use 891011. The glycyrrhetinic acid component of licorice is metabolized to 3-monoglucuronyl-glycyrrhetinic acid (3MGA), which inhibits 11-beta-hydroxysteroid dehydrogenase and reduces cortisol breakdown, resulting in a hypermineralocorticoid effect 1213.

Why it happens (mechanism)

Licorice-induced hypokalemia may increase the risk of digoxin toxicity

Literature reports

1 report — tap to read

a) An 84-year-old male developed hypokalemia and symptoms of congestive heart failure after 7 days of concurrent use of a licorice-containing Chinese herbal laxative with digoxin and furosemide. The patient complained of fatigue, appetite loss, and lower extremity edema. Pulse rate was 30 beats per minute, potassium was 2.9 milliequivalents/Liter (mEq/L), and digoxin level 2.9 nanograms/milliliter (ng/mL). Chest radiograph revealed an enlarged cardiac silhouette and lung congestion. Partial arterial oxygen pressure and saturation was low, carbon dioxide pressure was high. Plasma renin activity was 0.3 ng/mL/hour (normal 0.3 to 2.9 ng/mL/hour) and aldosterone was 3.8 nanograms/deciliter (ng/dL) (normal 3.6 to 24 ng/dL). Digoxin and the herbal laxative were stopped; after 18 days, the patient's pulse increased to 60 beats per minute and symptoms of congestive heart failure were relieved. Potassium increased to 4.3 mEq/L, renin activity was 1 ng/mL/hour, aldosterone was 12 ng/dL, and digoxin level was 0.6 ng/mL 1.

Common questions

Can I take Licorice and Digoxin together?

Increased risk of digoxin toxicity Always confirm with your pharmacist or prescriber before making any change.

How serious is the Licorice and Digoxin interaction?

It is rated moderate. Can be significant — usually manageable with monitoring.

How quickly could this interaction happen?

The documented onset is "delayed". Effects tend to build up gradually over days to weeks.

How strong is the evidence for this interaction?

The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.

From our Q&A

Real reader questions about these medications, each personally answered by our pharmacist:

Questions for your pharmacist

  • Does my dose of Licorice or Digoxin 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 anything you'd monitor while I'm on both?

References (13)

  1. Harada T, Ohtaki E, Misu K, et al: Congestive heart failure caused by digitalis toxicity in an elderly man taking a licorice-containing Chinese herbal laxative. Cardiology 2002; 98(4):218. PubMed
  2. Dellow EL, Unwin RJ, & Honour JW: Pontefract cakes can be bad for you: refractory hypertension and liquorice excess. Nephrol Dial Transplant 1999; 14:218-220. DOI
  3. Eriksson JW, Carlberg B, & Hillorn V: Life-threatening ventricular tachycardia due to liquorice-induced hypokalemia. J Int Med 1999; 245(3):307-310.
  4. Kageyama K, Watanobe H, Nishie M, et al: A case of pseudoaldosteronism induced by a mouth refresher containing licorice. Endocr J 1997; 44(4):631-632. PubMed
  5. Bernardi M, D'Intino PE, Trevisani F, et al: Effects of prolonged ingestion of graded doses of licorice by healthy volunteers. Life Sci 1994; 55(11):863-872. DOI
  6. Blachley JD & Knochel JP: Tobacco chewer's hypokalemia: licorice revisited. N Engl J Med 1980; 302(14):784-785. PubMed
  7. Wash LK & Bernard JD: Licorice-induced pseudoaldosteronism. Am J Hosp Pharm 1975; 32(1):73-74. DOI
  8. Hussain RM: The sweet cake that reaches parts other cakes can't!. Postgrad Med J 2003; 79:115-116. PubMed
  9. Lin SH, Yang SS, Chau T, et al: An unusual cause of hypokalemic paralysis: chronic licorice ingestion. Am J Med Sci 2003; 325(3):153-156. DOI
  10. Shintani S, Murase H, Tsukagoshi H, et al: Glycyrrhizin (Licorice)-induced hypokalemic myopathy. Eur Neurol 1992; 32(1):44-51. DOI
  11. Corsi FM, Galgani S, Gasparini C, et al: Acute hypokalemic myopathy due to chronic licorice ingestion: report of a case. Ital J Neurol Sci 1983; 4(4):493-497. DOI
  12. Kato H, Kanaoka M, Yano S, et al: 3-Monoglucuronyl-glycyrrhetinic acid is a major metabolite that causes licorice-induced pseudoaldosteronism. J Clin Endocrinol Metab 1995; 80(6):1929-1933. PubMed
  13. Walker BR & Edwards CRW: Licorice-induced hypertension and syndromes of apparent mineralocorticoid excess. Endocrinol Metab Clin North Am 1994; 23:359-377. DOI
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Digoxin

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All Digoxin interactions (453) Digoxin drug information
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Licorice

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Beyond drug–drug

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

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major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.