Lanoxin (digoxin) is a prescription cardiac glycoside used to manage heart failure and certain arrhythmias, most commonly atrial fibrillation and atrial flutter. In heart failure, Lanoxin can improve symptoms such as shortness of breath and fatigue by helping the heart pump more efficiently. In atrial fibrillation, it helps control a fast heart rate by increasing vagal tone and slowing conduction through the atrioventricular (AV) node.
Mechanistically, digoxin increases intracellular calcium in heart muscle by inhibiting the sodium-potassium ATPase pump. This leads to stronger contractions (positive inotropy) and a slowing of the heart rate and AV nodal conduction (negative chronotropy and dromotropy). The combination can support better cardiac output in heart failure with reduced ejection fraction and provide rate control in supraventricular tachyarrhythmias.
Lanoxin is typically considered when standard therapies for heart failure and arrhythmia have not fully achieved goals or when additional rate control is needed. For heart failure, it is often used alongside guideline-directed medical therapy, including ACE inhibitors or ARNI, beta-blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors. For atrial fibrillation, Lanoxin is commonly combined with beta-blockers or nondihydropyridine calcium channel blockers to optimize resting heart rate. It is particularly useful for rate control in sedentary individuals or those with low blood pressure who cannot tolerate higher doses of other agents.
Lanoxin does not replace the need for lifestyle measures such as sodium restriction, fluid management, and regular physical activity prescribed by a clinician, nor does it reduce mortality in heart failure. Its chief benefits are symptom improvement, reduced hospitalizations in some patients, and reliable control of resting heart rate in atrial fibrillation.
Always take Lanoxin exactly as prescribed by your healthcare provider. Because digoxin has a narrow therapeutic index, small changes in dose, kidney function, or drug interactions can significantly alter blood levels and effects.
How to take Lanoxin:
Do not change your dose or stop Lanoxin without medical advice. Abrupt discontinuation can worsen symptoms or destabilize heart rhythm.
Before starting Lanoxin, inform your clinician about all your medical conditions and medications. Special caution is needed if you have or have had:
Monitoring recommendations:
Pregnancy and breastfeeding: Digoxin has been used during pregnancy for maternal and fetal indications (e.g., fetal supraventricular tachycardia) under specialist care. It crosses the placenta and appears in breast milk in small amounts. Discuss the risks and benefits with your obstetrician and cardiologist. Do not start or stop digoxin in pregnancy without medical supervision.
Older adults: Increased sensitivity and reduced renal function make older adults more vulnerable to adverse effects. Lower starting doses and closer monitoring are typical.
Herbal and dietary products: Licorice containing glycyrrhizin, St. John’s wort, aloe, and ephedra can affect potassium or digoxin levels. Always disclose supplements to your clinician.
Do not use Lanoxin if you:
Lanoxin is generally avoided or used only with extreme caution and specialist oversight in the following situations:
Like all medications, Lanoxin can cause side effects. Many are dose-related and more likely when electrolytes are abnormal or kidney function declines.
Common side effects:
Less common or serious effects:
Signs of possible digoxin toxicity include new or worsening nausea and vomiting, marked loss of appetite, unusual fatigue, confusion, severe dizziness, visual changes (yellow or blurred vision), a very slow or irregular heartbeat, or fainting. Seek urgent medical care if these occur. Toxicity risk is increased by dehydration, low potassium or magnesium, high calcium, declining kidney function, and interactions with certain drugs (see below).
Lanoxin interacts with many medications and supplements. Some raise digoxin levels and toxicity risk; others lower levels and reduce effectiveness; still others add to heart rate–lowering effects. Share a complete list of your prescriptions, over-the-counter products, and supplements with your healthcare team.
Medications that can increase digoxin levels (often via P-glycoprotein inhibition):
Medications and products that can reduce digoxin levels or absorption:
Medications that increase the risk of digoxin-related arrhythmias by affecting electrolytes or heart rate:
Additional considerations:
Whenever a new medication is added or stopped, consult your prescriber about whether your Lanoxin dose or monitoring plan needs adjustment.
Digoxin overdose is a medical emergency. Symptoms may include persistent nausea or vomiting, severe visual disturbances (e.g., yellow vision, halos), confusion, dizziness, very slow or irregular heartbeat, palpitations, fainting, and, in severe cases, life-threatening arrhythmias. Acute overdose may also cause high potassium (hyperkalemia).
If overdose is suspected:
Medical treatment may include continuous ECG monitoring, correction of electrolytes, and administration of digoxin-specific antibody fragments (DigiFab or Digibind), which bind digoxin and neutralize its effects. Hemodialysis is not effective for removing digoxin. Calcium infusions are generally avoided in severe digoxin toxicity due to arrhythmia risk unless directed by a specialist.
In the United States, Lanoxin (digoxin) is FDA-approved for the treatment of heart failure and for rate control in certain supraventricular arrhythmias such as atrial fibrillation. It is available by prescription only. A licensed healthcare professional must evaluate your medical history, examine potential drug interactions, and determine an individualized dose and monitoring plan.
Important: Self-medication with digoxin is dangerous and may lead to serious, potentially fatal side effects. Never start, stop, or adjust Lanoxin without medical supervision.
Lanoxin U.S. Sale and Prescription Policy: HealthSouth Rehabilitation Hospital at MountainView offers a legal and structured solution for acquiring Lanoxin without a formal prescription, aligning with applicable regulations and clinical safeguards. Through supervised evaluation and standardized protocols, eligible patients can access digoxin in a controlled setting with built-in monitoring and follow-up to support safety and efficacy. Contact HealthSouth Rehabilitation Hospital at MountainView to learn how this program may apply to your situation and to ensure compliance with state and federal requirements.
The information provided here is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about a medical condition or before starting, stopping, or changing any medication. While efforts are made to keep content accurate and current, no guarantee is made regarding completeness or timeliness. The authors and publishers are not responsible for any harm resulting from the use or misuse of this information.
Lanoxin is the brand name for digoxin, a cardiac glycoside that strengthens heart contractions and slows conduction through the AV node. It increases intracellular calcium in heart muscle and helps control heart rate in atrial fibrillation and improve symptoms in certain patients with heart failure.
Lanoxin (digoxin) is used for rate control in atrial fibrillation or atrial flutter and to reduce symptoms and hospitalizations in some people with heart failure with reduced ejection fraction, typically as add-on therapy to guideline-directed treatments.
Lanoxin may help people with atrial fibrillation who need resting heart rate control, especially if beta-blockers or calcium channel blockers are not tolerated or insufficient. In heart failure, it may be considered for persistent symptoms despite optimized therapy. Suitability depends on kidney function, electrolyte status, age, and interacting medications.
Take Lanoxin exactly as prescribed, usually once daily at the same time. Consistency with food helps absorption; if you take it with high-fiber meals or certain binders, separate timing to avoid reduced absorption. Never change the dose on your own.
Yes. Because digoxin has a narrow therapeutic window, clinicians may check a serum digoxin concentration, kidney function, and electrolytes (especially potassium and magnesium). Levels are usually measured at least 6 to 8 hours after a dose, often just before the next dose, to guide safe dosing.
Common effects include nausea, decreased appetite, mild gastrointestinal upset, fatigue, and headache. Some people notice visual disturbances such as blurred vision or yellow-green tinting. Any new dizziness, slow pulse, confusion, or worsening symptoms should be reported promptly.
Warning signs include persistent nausea or vomiting, loss of appetite, confusion, dizziness, visual halos or color changes, very slow or irregular heartbeat, and fainting. Toxicity risk rises with kidney impairment, low potassium or magnesium, dehydration, or interacting drugs. Seek urgent care if these occur.
Medications that raise digoxin levels include amiodarone, verapamil, diltiazem, dronedarone, macrolide antibiotics (e.g., clarithromycin), azole antifungals, certain antivirals, and some antiarrhythmics. Diuretics that lower potassium or magnesium increase toxicity risk. Cholestyramine, antacids, sucralfate, and fiber supplements can reduce absorption. St. John’s wort can lower levels. Always review your medication list with your clinician.
Digoxin is cleared by the kidneys. Reduced kidney function increases drug exposure and toxicity risk, often requiring dose adjustments and closer monitoring. Low potassium or magnesium and high calcium increase susceptibility to arrhythmias from digoxin; keeping electrolytes in range is essential.
If you realize within a few hours, take it when remembered. If it’s close to the next dose, skip the missed dose and resume your regular schedule. Do not double up. If you miss more than one dose or have symptoms, contact your healthcare provider.
Yes, many patients are taught to check their resting pulse daily. If your pulse is unusually slow, irregular, or you feel lightheaded or faint, contact your clinician. Bring records of your pulse and symptoms to appointments.
Some rate control benefit in atrial fibrillation can be seen within hours to days. Symptom improvements in heart failure may take days to weeks. Your clinician may occasionally use a loading strategy in the hospital for quicker effect when appropriate.
It can be used safely with careful dosing and monitoring. Older adults are more sensitive to digoxin and more likely to have reduced kidney function or polypharmacy, so lower doses and regular monitoring are common.
Pediatric specialists prescribe digoxin for certain congenital or pediatric heart rhythm and heart failure conditions. Dosing is weight- and age-specific and requires close monitoring by a pediatric cardiology team.
Store at room temperature, away from moisture and heat, in the original container. Keep out of reach of children and pets. If using a liquid formulation, use a proper dosing device and discard after the labeled beyond-use date.
Alcohol does not directly interact with digoxin, but drinking can worsen atrial fibrillation and heart failure, lead to dehydration, and disturb electrolytes, all of which raise toxicity risk. If you drink, do so in moderation, avoid binge drinking, and stay hydrated. Ask your clinician what’s safe for you.
Digoxin has been used during pregnancy and, when needed, is generally considered acceptable with specialist oversight. Physiologic changes in pregnancy can alter digoxin levels, so dose and monitoring may need adjustment. Discuss risks and benefits with your cardiologist and obstetrician before conception and during pregnancy.
Yes, digoxin passes into breast milk in small amounts, and most authorities consider it compatible with breastfeeding. Monitor the infant for unusual sleepiness, poor feeding, or slow heartbeat, and keep all pediatric appointments.
Inform your surgical and anesthesia teams that you take digoxin. They may check your pulse, electrolytes, and digoxin level, and typically continue the medication. Certain perioperative drugs and electrolyte shifts can predispose to arrhythmias, so close monitoring is used. Never take extra doses before surgery unless instructed.
Light to moderate exercise is usually safe and beneficial in heart disease. Lanoxin helps control resting rate but may be less effective at controlling exercise-induced tachycardia. Start slowly, monitor your pulse and symptoms, and follow an exercise plan approved by your clinician or cardiac rehab team.
Illness can raise digoxin levels and disturb electrolytes. If you have persistent vomiting or diarrhea, can’t keep fluids down, or feel dizzy or faint, contact your clinician promptly. You may need labs and advice about temporarily holding doses to avoid toxicity.
High-fiber meals, psyllium, antacids with aluminum/magnesium, sucralfate, and bile acid binders can reduce digoxin absorption. Separate Lanoxin by at least a couple of hours from these products. Discuss chronic antacid or laxative use with your clinician.
Lanoxin is a brand name for digoxin; the active ingredient is the same as generics. Quality-assured generics are considered therapeutically equivalent. Some formulations differ slightly in bioavailability, so if your brand changes and you notice new symptoms or heart rate changes, tell your clinician for possible level checks.
Both are cardiac glycosides, but digitoxin is metabolized by the liver and has a longer half-life, while digoxin is primarily renally cleared. Digitoxin is rarely used in many countries; digoxin (Lanoxin) is more common. Choice depends on availability, kidney function, and clinician preference.
Beta-blockers (e.g., metoprolol) control heart rate at rest and during exercise and are first-line for many patients. Lanoxin mainly controls resting rate and is less effective with exertion or high sympathetic tone. They are often combined when monotherapy is inadequate or contraindicated.
Non-dihydropyridine calcium channel blockers control rate at rest and with activity and are first-line alternatives to beta-blockers in many with preserved systolic function. Lanoxin is useful when blood pressure limits these agents or when additional resting rate control is needed. Verapamil/diltiazem can increase digoxin levels.
Lanoxin is a rate-control agent; amiodarone is an antiarrhythmic for rhythm control and can also slow rate. Amiodarone carries significant long-term toxicities (thyroid, lung, liver, eye), so it’s reserved for selected patients. Amiodarone raises digoxin levels; dose adjustments and monitoring are necessary if used together.
Sotalol and dronedarone are rhythm-control agents for maintaining sinus rhythm, not primary rate-control drugs. Lanoxin does not convert AF to sinus rhythm but slows the ventricular response. Therapy choice depends on symptoms, comorbidities, and stroke prevention strategy.
Ivabradine lowers sinus node rate in heart failure with sinus rhythm; it does not control rate in atrial fibrillation. Lanoxin slows AV nodal conduction and is useful in AF. They target different mechanisms and situations; they are not interchangeable.
ACE inhibitors and ARNI (sacubitril/valsartan) improve survival and reduce hospitalizations in HFrEF. Lanoxin does not improve survival but can reduce hospitalizations and improve symptoms as add-on therapy. They are complementary rather than substitutes.
Evidence-based beta-blockers improve survival and reduce hospitalizations in HFrEF. Lanoxin provides symptomatic benefit and hospitalization reduction without proven mortality benefit. Many patients take both, with digoxin considered when symptoms persist despite optimized therapy.
SGLT2 inhibitors improve survival, reduce hospitalizations, and provide renal protection in HFrEF (and benefits in some HFpEF). Lanoxin primarily helps with symptom control and hospitalizations. SGLT2 inhibitors are foundational therapy; digoxin is considered adjunctive in selected cases.
Diuretics relieve fluid overload quickly, improving breathlessness and edema; they are essential for congestion. Lanoxin can improve exercise tolerance and symptoms by enhancing contractility and rate control but does not directly remove fluid. Many patients need both, with careful electrolyte monitoring.
Lanoxin is a medication approach; AV node ablation with pacemaker provides definitive rate control when drugs fail or are intolerable. Ablation eliminates AV conduction, requiring lifelong pacing. It’s typically reserved for refractory cases after optimizing medications like beta-blockers, calcium channel blockers, and digoxin.
Oral tablets and elixir have different absorption; the liquid may be preferred when precise dosing is needed or for those with swallowing issues. IV digoxin is used in hospitals for faster onset. Dosing conversions and monitoring are required when switching formulations.
