Drug Interaction Report

Sotalol and Digoxin: Interaction Details

A pharmacist-reviewed analysis of the Sotalol 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®
+

Sotalol

Betapace Betapace® Betapace® AF Sorine Sorine® Sotylize
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
Major
Potentially serious — often needs a change or close 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 124 documented Sotalol interactions, 75 are rated major — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
unspecified
Evidence
theoretical
Severity
Major

What happens

Increased risk of bradycardia, advanced or complete heart block and an increased risk of proarrhythmic events

Interaction Deep Dive

Coadministration of digoxin and sotalol (beta blocker) may increase the risk of proarrhythmic events243. Both digoxin and sotalol slow atrioventricular conduction and reduce heart rate, and concurrent use can also increase the risk of bradycardia or hypotension 567, and advanced or complete heart block 124.

Why it happens (mechanism)

Additive effects on AV node conduction

Literature reports

1 report — tap to read

a) The effect of adding sotalol (80 to 320 mg daily) to digoxin in a placebo-controlled trial was studied. Heart rates were lower in the sotalol group and 2 of the 24 patients had to cease sotalol therapy due to excessive asymptomatic bradycardia 8.

Common questions

Can I take Sotalol and Digoxin together?

Increased risk of bradycardia, advanced or complete heart block and an increased risk of proarrhythmic events Always confirm with your pharmacist or prescriber before making any change.

How serious is the Sotalol and Digoxin interaction?

It is rated major. Potentially serious — often needs a change or close 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 "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.

Questions for your pharmacist

  • Does my dose of Sotalol 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 a safer alternative to one of these medications for me?

References (8)

  1. Product Information: LANOXIN(R) oral tablets, digoxin oral tablets. Concordia Pharmaceuticals Inc (per FDA), Kansas City, MO, 2019. DailyMed
  2. Product Information: DIGOXIN oral tablets, digoxin oral tablets. Aurobindo Pharma USA, Inc. (per Dailymed), East Windsor, NJ, May. DailyMed
  3. Product Information: DIGOXIN intravenous injection, digoxin intravenous injection. Hikma Pharmaceuticals USA Inc. (per Dailymed), Berkeley Heights, NJ, 2023. DailyMed
  4. Product Information: LANOXIN® intravenous, intramuscular injection, digoxin intravenous, intramuscular injection. Covis Pharma (per FDA), King of Prussia, PA, 2025. DailyMed
  5. Product Information: BETAPACE(R) oral tablets, sotalol HCl oral tablets. Covis Pharma (per FDA), King of Prussia, PA, 2021. DailyMed
  6. Product Information: BETAPACE(R) AF oral tablets, sotalol HCl oral tablets. Covis Pharma (per FDA), King of Prussia, PA, 2021. DailyMed
  7. Product Information: BETAPACE(R) AF oral tablets, sotalol HCl oral tablets. Covis Pharmaceuticals, Inc. (per FDA), Chesterbrook, PA, 2016. DailyMed
  8. Singh S, Saini RK, DiMarco J, et al: Efficacy and safety of sotalol in digitalized patients with chronic atrial fibrillation. Am J Cardiol 1991; 68:1227-1230. DOI
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Digoxin

Keep reading about Digoxin

All Digoxin interactions (453) Digoxin drug information
Also serious with: Levoketoconazole Meclofenamate Mavorixafor Parathyroid Hormone Injection
Sotalol

Keep reading about Sotalol

All Sotalol interactions (124) Sotalol drug information
Also serious with: Eribulin Injection Sertraline Oxaliplatin Injection Dasatinib
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:

Digoxin + Activated Charcoal Aloe Blue Flag Danshen European Buckthorn Foxglove Indian Snakeroot Lily-of-the-valley + 105 more
Sotalol + Activated Charcoal American Hellebore Arsenic Cesium Ephedra Grapefruit Indian Snakeroot Sida Cordifolia + 35 more

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.