Cardiac glycosides

Last updated: September 6, 2023

Summarytoggle arrow icon

Cardiac glycosides are drugs that inhibit the Na+/K+- ATPase found on the outer cell surface. Digoxin is the only drug of this class that is commonly used in clinical settings. The main indications for digoxin treatment are atrial fibrillation and heart failure in treatment-resistant cases. Because cardiac glycosides have a narrow therapeutic index, close monitoring of serum concentrations is necessary. Typical symptoms of cardiac glycoside poisoning are nausea, vomiting, blurry vision, and cardiac arrhythmias. Overdose can quickly become life-threatening and swift treatment is vital. The first-line treatment for cardiac glycoside poisoning is administration of digoxin-specific antibodies.

See also “Digoxin poisoning.”

Overviewtoggle arrow icon

  • Drugs: digoxin, ouabain
  • Mechanism: inhibition of the cardiac and neuronal Na+/K+- ATPase
  • Onset of effect
    • Oral: 0.5–2 h
    • IV: 15–30 min
  • Half-life: 36–40 hours
  • Protein binding: 20–40%
  • Elimination: renal


Pharmacodynamicstoggle arrow icon

Cardiac glycosides inhibit Na+/K+-ATPase, increasing cardiac contractility and decreasing AV conduction and heart rate!

Cardiac glycoside poisoningtoggle arrow icon

Indicationstoggle arrow icon


Contraindicationstoggle arrow icon


We list the most important contraindications. The selection is not exhaustive.

Interactionstoggle arrow icon

Referencestoggle arrow icon

  1. Katzung B,Trevor A. Basic and Clinical Pharmacology. McGraw-Hill Education ; 2014
  2. Levine M, O'Connor A, Traub SJ, Burns MM, Grayzel J. Digitalis (Cardiac Glycoside) Poisoning. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: February 7, 2017. Accessed: July 21, 2017.
  3. Giardina E-G, Sylvia L, Olshansky B, Downey BC. Treatment with Digoxin: Initial Dosing, Monitoring, and Dose Modification. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: June 8, 2017. Accessed: July 21, 2017.
  4. Goldberger AL, Traub SJ, Downey BC. Cardiac Arrhythmias due to Digoxin Toxicity. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: August 28, 2015. Accessed: July 21, 2017.
  5. UpToDate. Digoxin: Drug Information. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: January 1, 2017. Accessed: July 21, 2017.
  6. Nelson LS, Howland M, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS. Goldfrank's Toxicologic Emergencies, 11th edition. McGraw-Hill Education ; 2019
  7. Roberts DM, Gallapatthy G, Dunuwille A, Chan BS. Pharmacological treatment of cardiac glycoside poisoning. Br J Clin Pharmacol. 2015; 81 (3): p.488-495.doi: 10.1111/bcp.12814 . | Open in Read by QxMD
  8. Ma G, Brady WJ, Pollack M, et al. Electrocardiographic manifestations: Digitalis toxicity. J Emerg Med. 2001; 20 (2): p.145-152.doi: 10.1016/s0736-4679(00)00312-7 . | Open in Read by QxMD
  9. Le T, Bhushan V, Sochat M, Petersen M, Micevic G, Kallianos K. First Aid for the USMLE Step 1 2014. McGraw-Hill Medical ; 2014
  10. WebMD. Digoxin (Rx). Digoxin (Rx). New York, NY: WebMD. Updated: July 1, 2016. Accessed: July 21, 2017.
  11. WebMD. Digitek (Digoxin Tablets) Drug. Digitek (Digoxin Tablets) Drug. New York, NY: WebMD. Updated: February 23, 2017. Accessed: July 21, 2017.
  12. Patel V. Digitalis Toxicity. In: Rottman JN, Digitalis Toxicity. New York, NY: WebMD. Updated: January 4, 2017. Accessed: May 15, 2018.

Icon of a lock3 free articles remaining

You have 3 free member-only articles left this month. Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer