A Review Article AHerbal and Dietary Supplement–Drug Interactions in Patients Taking Digoxinbout Digoxin-Herb and Dietary Supplement Interactions

  • Forouzan Ahmadpour * 1Department of Pharmacotherapy, School of Pharmacy, Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran https://orcid.org/0000-0002-1142-6088
  • Fatemeh Ahmadpour Department of Clinical Biochemistry, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences. Ahvaz, Iran
Keywords: Digoxin, Herb-drug interaction, Food-drug interactions


Many people who use prescription medication also take complementary and alternative medicines such as a vitamin, minerals, herbal products, or other botanical drugs. The mechanisms of interaction can be based on the following methods: affecting the absorption, metabolism, and disposition of other drugs. Pharmacological effects of digoxin include the increased force of myocardial contraction, decreased heart rate and the activity of the sympathetic nervous system. Digoxin is characterized by a narrow therapeutic index and is the potential drug for interacting with other drugs, herbs, and supplements. Since these interactions can cause fatal and dangerous complications; with regard to these properties, we decided to review the evidence about the interaction between herbal-dietary supplements and digoxin. We searched several sources, including MEDLINE (PubMed), Embase, CINAHL, the Cochrane Library, CISCOM databases from 1970 to 2018. Our keyboards for the search were digoxin interactions, digoxin-drug interaction, digoxin-supplement interaction, and herb-drug interaction. We reviewed the following types of articles for writing this review article: case reports, case series, original articles, and review articles. Taking together, 210 articles were obtained from databases. However, only seventy-one related articles were chosen for the preparation of this review article. We found fifty herbal products that could interact via a different mechanism with digoxin. St. John’s wort has the most documented interactions with digoxin. Some of the information on these reviews resulted from in vitro and animal studies with no clinical evidence, and others resulted from clinical evidence. Therefore, our confirmation of them in the body is incomplete. We recommend that the use of these herbs with digoxin be avoided.


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Review Article