Drug General Information (ID: DDIE2OZQYR)
Drug Name			Digoxin		Drug Info		Licorice		Drug Info
Drug Type		Small molecule				Natural product
Therapeutic Class		Antiarrhythmic Agents				Herbal Products
Structure

Mechanism of Digoxin-Licorice Interaction (Severity Level: Moderate)
Increased risk of hypokalemia Click to Show/Hide Mechanism Graph
Drug Name		Digoxin				Licorice
Mechanism		Hypokalemia				Hypokalemia
Key Mechanism Factor 1
		Factor Name		Hypokalemia
		Factor Description		Hypokalemia is a condition in which the amount of potassium in your blood is lower than normal. If you are mildly hypokalemic, you may not have any signs or symptoms, but severe hypokalemia may have the following symptoms: fatigue, constipation, frequent or heavy urination, muscle cramps or skin tingling, muscle weakness, and a fast or irregular heartbeat.
Mechanism Description		Increased risk of hypokalemia by the combination of Digoxin and Licorice

Recommended Action
Management		Patients should consult a healthcare provider before taking any herbal or alternative medicine. In general, chronic use of licorice and licorice-containing products should be avoided in patients treated with cardiac glycosides.

References
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3	Cumming AM, Boddy K, Brown JJ, et al "Severe hypokalaemia with paralysis induced by small doses of liquorice." Postgrad Med J 56 (1980): 526-9. [PMID: 7443613]
4	de Klerk GJ, Nieuwenhuis MG, Beutler JJ "Lesson of the week: hypokalaemia and hypertension associated with use of liquorice flavoured chewing gum." BMJ 314 (1997): 731. [PMID: 9116553]
5	Edwards CR "Lessons from licorice." N Engl J Med 325 (1991): 1242-3. [PMID: 1656256]
6	Elinav E, Chajek-Shaul T "Licorice consumption causing severe hypokalemic paralysis." Mayo Clin Proc 78 (2003): 767-8. [PMID: 12934789]
7	Farese RV, Biglieri EG, Shackleton CH, Irony I, Gomez-Fontes R "Licorice-induced hypermineralocorticoidism." N Engl J Med 325 (1991): 1223-7. [PMID: 1922210]
8	Harada T, Ohtaki E, Misu K, Sumiyoshi T, Hosoda S "Congestive heart failure caused by digitalis toxicity in an elderly man taking a licorice-containing chinese herbal laxative." Cardiology 98 (2002): 218. [PMID: 12566654]
9	Nielsen I, Pedersen RS "Life-threatening hypokalaemia caused by liquorice ingestion." Lancet 1 (1984): 1305. [PMID: 6145019]
10	Rosseel M, Schoors D "Chewing gum and hypokalaemia." Lancet 341 (1993): 175. [PMID: 8093767]
11	Stewart PM, Wallace AM, Valentino R, Burt D, Shackleton CH, Edwards CR "Mineralocorticoid activity of liquorice: 11-beta-hydroxysteroid dehydrogenase deficiency comes of age." Lancet 2 (1987): 821-4. [PMID: 2889032]