When your heart doesn’t pump right, doctors often turn to digoxin. It’s been around since the 1700s, pulled from foxglove plants, and still used today for heart failure and atrial fibrillation. But it’s not the only option-and for many patients, it’s not even the best one anymore. With newer drugs that are safer, more predictable, and easier to manage, why do some still get digoxin? And when should you ask your doctor about switching?
How Digoxin Actually Works
Digoxin slows down the heart rate and makes each beat stronger. It does this by blocking a pump in heart cells called the sodium-potassium ATPase. That sounds technical, but here’s what it means in real life: your heart doesn’t have to work as hard to push blood out, and it beats more regularly. That’s why it’s used for two main problems: heart failure (when the heart can’t pump enough blood) and atrial fibrillation (when the upper chambers of the heart flutter instead of beating normally).
But digoxin doesn’t save lives. It doesn’t reduce death rates like beta-blockers or ACE inhibitors do. It just helps you feel better. If you’re short of breath, swollen, or tired from heart failure, digoxin might give you a little more energy. But if your heart rhythm is chaotic, it can help slow it down enough to reduce symptoms-without fixing the root cause.
Why Digoxin Is Risky
Digoxin has a very narrow window between helping and hurting. Too little? It does nothing. Too much? You could get dangerous heart rhythms, nausea, confusion, or even cardiac arrest. That’s why doctors have to check your blood levels regularly-usually every few months, or after any dose change.
Many things affect how your body handles digoxin. Kidney problems? It builds up. Low potassium or magnesium? You’re more likely to overdose. Taking it with common drugs like amiodarone, verapamil, or even some antibiotics? Your digoxin level can spike overnight. A 72-year-old with mild kidney disease on digoxin and a new prescription for trimethoprim? That’s a recipe for hospitalization.
Studies from the American Heart Association show that nearly 20% of digoxin users have levels outside the safe range. And older adults? They’re at highest risk. That’s why many guidelines now say: avoid digoxin unless absolutely necessary.
Best Alternatives for Heart Failure
If your main issue is heart failure with reduced pumping ability (HFrEF), digoxin is no longer first-line. The real game-changers came in the last decade:
- SGLT2 inhibitors (like dapagliflozin and empagliflozin): Originally for diabetes, these drugs reduce hospitalizations and death in heart failure-even if you don’t have diabetes. They work by helping your kidneys flush out extra salt and water, lowering pressure on the heart.
- ARNIs (sacubitril/valsartan): This combo drug replaces ACE inhibitors or ARBs in many cases. It’s been shown to cut death risk by 20% compared to enalapril.
- Beta-blockers (carvedilol, bisoprolol, metoprolol succinate): These slow your heart rate, lower blood pressure, and reduce stress on the heart muscle. They’re proven to extend life.
- MRA (spironolactone, eplerenone): These block hormones that cause fluid retention and scarring in the heart.
These drugs don’t just manage symptoms-they change the disease’s course. They’re taken once daily, have fewer interactions, and don’t require blood tests every month. For most patients with HFrEF, these are the standard now. Digoxin? It’s reserved for those who still have symptoms after trying all of the above.
Alternatives for Atrial Fibrillation
For atrial fibrillation, the goal is either controlling the heart rate or restoring normal rhythm. Digoxin was once the go-to for rate control, especially in sedentary older patients. But today, it’s rarely the first choice.
- Beta-blockers: Faster acting, more reliable, and safer. They’re the top pick for most patients.
- Calcium channel blockers (diltiazem, verapamil): Great for active patients who can’t tolerate beta-blockers. They work quickly and don’t lower blood pressure as much.
- Amiodarone: Used for rhythm control, not just rate. But it has serious long-term side effects-lung, liver, thyroid issues-so it’s not for everyone.
- Dronedarone: A safer cousin of amiodarone, but it doesn’t work as well and isn’t for patients with severe heart failure.
Even more important: anticoagulants. If you have atrial fibrillation, you’re at higher risk for stroke. Warfarin, apixaban, rivaroxaban, dabigatran-these drugs prevent clots. Digoxin doesn’t do that. So if you’re on digoxin for AFib and not on a blood thinner, you’re missing the most critical part of treatment.
When Digoxin Might Still Make Sense
It’s not all bad news. Digoxin still has a role-in specific cases.
- You have persistent symptoms of heart failure despite being on all guideline-recommended meds.
- You can’t tolerate beta-blockers or calcium channel blockers due to low blood pressure or asthma.
- You’re an older adult with mild kidney function and atrial fibrillation, and your doctor can monitor your levels closely.
- You’re in a setting where newer drugs aren’t available or affordable.
Even then, the dose is low-usually 0.0625 to 0.125 mg once a day. That’s half or a quarter of what was common 20 years ago. And it’s only used when everything else has been tried.
What Patients Should Ask Their Doctor
If you’re on digoxin, here are four questions to ask at your next visit:
- Why am I still on digoxin? Is it because I need it, or because we’ve never switched?
- Have my blood levels been checked in the last 3 months?
- Am I on all the other recommended heart failure or AFib meds? If not, why?
- Could I try a safer alternative? What would that look like?
Don’t stop digoxin on your own. But do push for a review. Many patients stay on it out of habit, not because it’s the best option.
Cost and Accessibility
Digoxin costs less than $10 a month in the U.S. Most newer drugs-SGLT2 inhibitors, ARNIs-are expensive without insurance. But many have patient assistance programs. Generic versions of beta-blockers and MRAs cost under $5. If cost is a barrier, talk to your pharmacist or doctor about options. Sometimes switching to a cheaper drug that’s more effective is the smartest move.
Final Takeaway
Digoxin isn’t obsolete-but it’s no longer the star. It’s more like a backup player. For heart failure and atrial fibrillation, newer drugs offer better survival, fewer side effects, and less monitoring. If you’ve been on digoxin for years, it’s worth asking whether you’re still getting the best care-or just the same care you’ve always had.
Is digoxin still commonly prescribed today?
Yes, but far less than before. It’s mostly used today for patients with persistent heart failure symptoms who can’t tolerate other medications, or for elderly patients with atrial fibrillation who need a simple, low-cost option-with close monitoring. Guidelines now recommend newer drugs first.
Can you take digoxin with other heart medications?
Some combinations are dangerous. Digoxin interacts with amiodarone, verapamil, diltiazem, quinidine, and certain antibiotics like clarithromycin. These can raise digoxin levels to toxic amounts. Always check with your doctor or pharmacist before starting or stopping any new medication.
What are the signs of digoxin toxicity?
Early signs include nausea, vomiting, loss of appetite, and blurry or yellow-tinted vision. Later signs are irregular heartbeat, dizziness, confusion, and fatigue. If you notice any of these, especially if you’re older or have kidney issues, contact your doctor immediately. A simple blood test can check your digoxin level.
Do I need blood tests if I’m on digoxin?
Yes. Blood levels should be checked 6-8 hours after your last dose, at least once when starting, then every 3-6 months if stable. More often if your kidney function changes, you start a new drug, or you have symptoms of toxicity. Safe levels are 0.5-0.9 ng/mL-higher than many people think.
Is digoxin safe for older adults?
It’s risky. Older adults often have reduced kidney function, which causes digoxin to build up. They’re also more sensitive to its effects on the heart. Many experts recommend avoiding it in people over 75 unless there’s no other option. If used, start with the lowest possible dose and monitor closely.
Can digoxin be replaced with a natural remedy?
No. While digoxin comes from foxglove, the plant itself is extremely toxic and unpredictable. There’s no safe, effective herbal version. Supplements like hawthorn or CoQ10 may help with symptoms slightly, but they don’t replace proven medications. Never stop digoxin for an unproven remedy.
If you’re on digoxin, don’t assume it’s the best choice just because it’s old. Ask questions. Review your options. With today’s medications, you can often get better results with fewer risks.
Christopher K
November 20, 2025 AT 14:54Oh wow, another article telling us digoxin is ‘outdated’ like it’s some medieval torture device. Meanwhile, my 82-year-old grandma’s on it, feels better than she has in 10 years, and her kidney function? Fine. You guys act like these ‘new’ drugs are magic bullets when half of them cost more than my car payment. Let people breathe. Not everyone’s got fancy insurance or a cardiologist on speed dial.