5 Digoxin Side Effects That You Should Know About

Foxglove is a plant that has been used to make treatments for heart conditions throughout history, with the earliest recorded use in the 13th century. In the mid-1950s, digoxin (Lanoxin) — a medication that comes from foxglove — first gained FDA-approval in the U.S. Since then, it’s been used to treat a number of different heart conditions. 

Although digoxin has been around for a while, it may not be the first choice for your condition. That's because it can cause some pretty serious side effects. Below, we’ll cover common digoxin side effects, digoxin toxicity, and what you should expect when taking this medication.

What is digoxin used for?

Digoxin is FDA-approved to treat mild to moderate heart failure in adults, and to help control heart rhythm in adults with atrial fibrillation. It’s also approved to help improve the heart’s ability to contract in children with heart failure. 

Digoxin comes as a tablet, injection, and liquid. The injection is typically only given in a healthcare setting. The tablets can be taken by adults and children as young as 5 years old. And the liquid option can be taken by children of any age, including premature infants. 

Although digoxin has been used for decades to treat heart conditions, there are newer treatment options that are more effective with less severe side effects. Read on to find out some specifics about digoxin side effects.

Potential digoxin side effects 

Digoxin side effects occur in around 5% to 20% of people taking the medication. The most common side effects are heart-related, followed by gastrointestinal (GI) problems. Side effects are more common for people taking a higher-than-recommended dosage. 

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If you’re taking digoxin, you’ll need regular blood work to ensure that the medication levels are within a normal range. If they’re too high, you might be at risk for side effects — or even digoxin toxicity — which we’ll cover below.

1. Blurred vision

Digoxin can cause several different kinds of vision problems, like blurry vision and the appearance of floaters or flashes in the vision. 

Other vision problems that have been reported include:

• Lower clarity of vision

• Yellow hue to vision

• Appearance of visual hallucinations

• Yellow halos around lights

• Sensitivity to glares

• Impairment of color vision

Most of these visual disturbances are due to the effect digoxin has on the retina. And they can also be signs of digoxin toxicity. Changes to vision should go away within days to weeks after you stop taking digoxin. Older adults and people with pre-existing vision problems or other medical conditions, especially kidney problems, are more at risk for these side effects. 

2. Gastrointestinal problems

GI side effects account for about 25% of reported digoxin side effects. These include nausea and vomiting, diarrhea, and reduced appetite. Abdominal pain, less blood flow to the intestines, and intestinal bleeding have also been reported. 

Although GI problems are one of the most common side effects of digoxin, they may be an early sign of digoxin toxicity. And they can also be signs of heart failure, too. So, it’s important to tell your healthcare provider about any side effects you’re experiencing. They can make sure you’re receiving an appropriate and effective dosage.

3. Gynecomastia

Gynecomastia is a condition in which men develop breasts. Several different medications can cause this problem, including digoxin. It happens more commonly in people who’ve been taking digoxin for a long period of time. 

Digoxin is thought to cause gynecomastia due to its chemical structure being similar to estrogen. So, it might mimic the actions of estrogen in the body. And estrogen is a key hormone in breast development. 

Gynecomastia usually goes away on its own after stopping the medication that’s causing it. However, digoxin is used to treat serious heart problems. You should never stop taking it unless your healthcare provider has instructed you to do so. 

4. Confusion and dizziness

Digoxin can affect the central nervous system, which can result in confusion and dizziness in some people. Older adults may even develop drug-induced delirium while taking it. This is when your mental state is affected, resulting in confusion, disorientation, and the inability to think clearly.

Although these are common side effects from digoxin, dizziness and low energy can also be a sign of digoxin toxicity, especially in older people. 

5. Changes in heart rate

Digoxin is used to treat abnormal heart rhythms. But it can also cause an irregular or slow heart rate in some people. This is more common with higher doses.

People with certain heart conditions, like Wolff-Parkinson-White syndrome or sinus node dysfunction, may be more at risk for heart rhythm side effects. Some people might even develop heart block — a condition in which the heart’s electrical signals either slow down or stop completely. It may be necessary for those with certain pre-existing heart conditions to get a pacemaker to regulate their heart rate before digoxin treatment is started.  

Seek immediate medical attention if you’re experiencing chest pain, shortness of breath, and irregular or abnormally fast or slow heartbeats.

Other digoxin side effects to be aware of

Some other side effects that digoxin may cause include:

• Thrombocytopenia (low levels of blood cells involved in clotting)

• Rash

• Headache

• Low energy level

• Anxiety

• Depression

• Hallucinations

• Worsening heart conditions

Digoxin is considered a narrow therapeutic index medication. This means that it can lead to serious side effects, even with a small difference in blood levels. This is why routine blood tests are required to ensure that the amount of medication in your blood is within a target range.

Keep in mind: Any of the side effects described above can occur when digoxin is within the target range. But some of them can also be a sign of digoxin toxicity.   

Digoxin toxicity

Digoxin toxicity usually occurs when the amount of digoxin in your blood is over a certain amount. When this happens, it can lead to life-threatening heart problems. Around 1% of people with heart failure who take digoxin develop digoxin toxicity. 

But some people might be at higher risk for developing it, even at lower levels. Factors that can raise your risk for digoxin toxicity include:

• Older age

• Low body weight

• Kidney problems

• Taking medications that interact with digoxin

• Low potassium levels

GI symptoms, like nausea, vomiting, and persistent diarrhea, are the most common sign of digoxin toxicity. Some people may also experience yellow or green-tinted vision, fluttering heart rate, and trouble breathing. 

If you have any signs of digoxin toxicity, your provider will usually check the digoxin levels in your blood. If the toxicity you’re experiencing is life-threatening, you may be given a medication to reverse digoxin’s effects.

Make sure your healthcare provider and pharmacist have your current list of medications. That way, they can check for potential interactions with digoxin.

Bottom line

Digoxin can be used to treat heart failure and heart rhythm problems. But it comes with a number of potential side effects. Most commonly, these include GI side effects like nausea and vomiting. In some cases, digoxin toxicity can occur. This can be life-threatening if your blood levels get too high.

Some people may be at higher risk of digoxin toxicity, even at lower blood levels. So, it should be used with caution in older people and those with kidney problems or other health conditions. Talk to your healthcare provider if you have questions about digoxin side effects, and if it’s right for you.

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Written by:

Sarah Lobello Pearson, PharmD

Sarah Pearson is a practicing pharmacist with over 10 years of experience in the field. She received her doctorate in pharmacy from the University of Georgia in Athens, GA.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

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