Propranolol and Digoxin: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Digoxin
Propranolol
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
Increased risk of bradycardia and possible digitalis glycoside toxicity
Interaction Deep Dive
Both digitalis glycosides and beta-blockers slow atrioventricular conduction and decrease heart rate, and concurrent use can increase the risk of bradycardia3412. If digitalis glycosides and beta-blockers are coadministered, monitor heart rate and PR interval 34. If severe bradycardia develops, reduce or discontinue metoprolol 1.
Why it happens (mechanism)
Additive effects on AV node conduction
Literature reports
1 report — tap to read
a) Carvedilol increased serum concentrations of digoxin in children; dose may need to be reduced to avoid toxicity. Eight children who received digoxin for ventricular failure secondary to complex congenital heart disease were observed for any pharmacokinetic interactions before and after the addition of carvedilol. The children ranged in age between 2 weeks and 7.8 years, and the carvedilol daily dose was titrated according to clinical response. The clearance of digoxin was calculated before and after at least 4 days of unchanged dose of carvedilol. In one child, there were 2 episodes of discontinuation, resulting in a decrease of the apparent clearance of digoxin and then a rebound of clearance when the drug was stopped. Carvedilol dose ranged from 0.1 mg/kg/day to 1.02 mg/kg/day. GFR did not change significantly before and after administration of carvedilol. There was a mean 2-fold decrease in the clearance of digoxin (from 153.0 +/- 92.3 mL/min/1.73 m(2) to 80.6 +/- 23.9 mL/min/1.73 m(2), p=0.056), and the ratio of digoxin clearance to the GFR decreased from 1.8 +/- 0.60 to 1.00 +/- 0.24 (p=0.002). Multiple regression analysis with age, initial ratio, and carvedilol dose confirmed univariate analysis, with the initial ratio the significant factor (p=0.05), whereas dose (p=0.78) and age (p=0.5) were not significant. The author concluded that the interaction between carvedilol and digoxin is enhanced in children possibly because of a higher expression of the P-glycoprotein pump 5.
Common questions
Can I take Propranolol and Digoxin together?
Increased risk of bradycardia and possible digitalis glycoside toxicity Always confirm with your pharmacist or prescriber before making any change.
How serious is the Propranolol and Digoxin interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Propranolol 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 (5)
- Product Information: TOPROL-XL(R) oral extended-release tablets, metoprolol succinate oral extended-release tablets. Aralez Pharmaceuticals US Inc (per FDA), Parsippany, NJ, 2022. DailyMed
- Product Information: KAPSPARGO SPRINKLE(R) oral extended-release capsules, metoprolol succinate oral extended-release capsules. Sun Pharmaceutical Industries Inc (per DailyMed), Cranbury, NJ, 2020. DailyMed
- Product Information: Lopressor(R) oral tablets, metoprolol tartrate oral tablets. Validus Pharmaceuticals, LLC (per FDA), Parsippany, NJ, 2013. DailyMed
- Product Information: Lopressor(R) intravenous injection, metoprolol tartrate intravenous injection. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2013. DailyMed
- Ratnapalan S, Griffiths K, Moldovan Costei A, et al: Digoxin-carvedilol interactions in children. J Pediatr 2003; 142:572-574. PubMed
Keep reading about Digoxin
Keep reading about Propranolol
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:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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