Definition and research guide
This page combines a MeSH definition, publication statistics and selected research abstracts. It is a starting point for reading the literature, not a medical textbook or a systematic evidence review.
Content available: 4 complete abstracts (681 words), 10 references. Full article text is not stored or reproduced here; follow the PMID, DOI or PMC links to read the original sources and their access terms.
Definition
A cardiotonic glycoside obtained mainly from Digitalis lanata; it consists of three sugars and the aglycone digoxigenin. Digoxin has positive inotropic and negative chronotropic activity. It is used to control ventricular rate in atrial fibrillation and in the management of congestive heart failure with atrial fibrillation. Its use in congestive heart failure and sinus rhythm is less certain. The margin between toxic and therapeutic doses is small. (From Martindale, The Extra Pharmacopoeia, 30th ed, p666)
Definition: NLM Medical Subject Headings (MeSH) scope note (Public domain (U.S. National Library of Medicine); attribution requested). View the MeSH record.
Also known as: Lanoxin; Lenoxin; Lanoxin-PG; Lanoxin PG; Lanoxicaps; Dilanacin; Mapluxin; Lanicor.
Where it fits in the MeSH classification
- Broader topics
- Digitalis Glycosides; Cardenolides
- Narrower topics
- Acetyldigoxins; Medigoxin; Digoxigenin
Related concepts
- Digoxigenin
- Atrial Fibrillation
Research landscape
PubMed indexes 12,905 records tagged with the MeSH heading “Digoxin” (counts retrieved 2026-10-31). 549 of them (4.3%) were published from 2020 onward, and the busiest period so far is through 1999 with 9,245 records.
Reviews account for 1,080 records (8.4%) and meta-analyses for 32. Randomized controlled trials number 595 (4.6%) as a share of all records on the topic.
Show the data
| Period | Records |
|---|---|
| through 1999 | 9,245 |
| 2000-2009 | 1,798 |
| 2010-2019 | 1,313 |
| 2020 onward | 549 |
Publication-type chart data
| Type | Records | Share |
|---|---|---|
| Reviews | 1,080 | 8.4% |
| Meta-analyses | 32 | 0.2% |
| Randomized controlled trials | 595 | 4.6% |
Method: PubMed query "Digoxin"[MeSH Terms] with publication-type and date filters, retrieved 2026-10-31.
Reading the evidence in drugs and chemicals
Studies of a chemical or drug can answer very different questions: what it is and how it behaves in cells and animals, how the body handles it, and whether it changes outcomes in people. Laboratory and animal findings often do not carry over to patients, and observational studies of exposures are confounded by who uses a substance and why. Nothing on this page is a recommendation to use, avoid, start or stop any substance or medicine; talk to a qualified clinician or pharmacist about your own situation. Check the dose, the species, the comparison group and whether a patient-relevant outcome was measured.
Evidence from open-access studies
These open-access studies come from PubMed’s best-match results for this heading (papers whose main topic it is), ranked here by citation count, with one recent addition. Each abstract is reproduced in full under its recorded open licence so that you can read the authors’ own words. They illustrate the literature; they are not a systematic summary of it. Citation counts measure attention, not reliability or clinical benefit.
Small-molecule TFEB pathway agonists that ameliorate metabolic syndrome in mice and extend C. elegans lifespan [1]
Abstract reading summary — source excerpts
- Opening excerpt
- Drugs that mirror the cellular effects of starvation mimics are considered promising therapeutics for common metabolic disorders, such as obesity, liver steatosis, and for ageing.
- Closing excerpt
- These results support the therapeutic potential of small-molecule TFEB activators for the treatment of metabolic and age-related disorders.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (157 words)
Drugs that mirror the cellular effects of starvation mimics are considered promising therapeutics for common metabolic disorders, such as obesity, liver steatosis, and for ageing. Starvation, or caloric restriction, is known to activate the transcription factor EB (TFEB), a master regulator of lipid metabolism and lysosomal biogenesis and function. Here, we report a nanotechnology-enabled high-throughput screen to identify small-molecule agonists of TFEB and discover three novel compounds that promote autophagolysosomal activity. The three lead compounds include the clinically approved drug, digoxin; the marine-derived natural product, ikarugamycin; and the synthetic compound, alexidine dihydrochloride, which is known to act on a mitochondrial target. Mode of action studies reveal that these compounds activate TFEB via three distinct Ca2+-dependent mechanisms. Formulation of these compounds in liver-tropic biodegradable, biocompatible nanoparticles confers hepatoprotection against diet-induced steatosis in murine models and extends lifespan of Caenorhabditis elegans. These results support the therapeutic potential of small-molecule TFEB activators for the treatment of metabolic and age-related disorders.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 29273768 · DOI · PMC5741634
Antiviral activity of digoxin and ouabain against SARS-CoV-2 infection and its implication for COVID-19 [2]
Abstract reading summary — source excerpts
- Opening excerpt
- The current coronavirus (COVID-19) pandemic is exacerbated by the absence of effective therapeutic agents.
- Closing excerpt
- Collectively, these results suggest that DIG and OUA may be an alternative treatment for COVID-19, with potential additional therapeutic effects for patients with cardiovascular disease.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (181 words)
The current coronavirus (COVID-19) pandemic is exacerbated by the absence of effective therapeutic agents. Notably, patients with COVID-19 and comorbidities such as hypertension and cardiac diseases have a higher mortality rate. An efficient strategy in response to this issue is repurposing drugs with antiviral activity for therapeutic effect. Digoxin (DIG) and ouabain (OUA) are FDA drugs for heart diseases that have antiviral activity against several coronaviruses. Thus, we aimed to assess antiviral activity of DIG and OUA against SARS-CoV-2 infection. The half-maximal inhibitory concentrations (IC50) of DIG and OUA were determined at a nanomolar concentration. Progeny virus titers of single-dose treatment of DIG, OUA and remdesivir were approximately 103-, 104- and 103-fold lower (> 99% inhibition), respectively, than that of non-treated control or chloroquine at 48 h post-infection (hpi). Furthermore, therapeutic treatment with DIG and OUA inhibited over 99% of SARS-CoV-2 replication, leading to viral inhibition at the post entry stage of the viral life cycle. Collectively, these results suggest that DIG and OUA may be an alternative treatment for COVID-19, with potential additional therapeutic effects for patients with cardiovascular disease.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 33004837 · DOI · PMC7530981
A cytochrome P450 CYP87A4 imparts sterol side-chain cleavage in digoxin biosynthesis [3]
Abstract reading summary — source excerpts
- Opening excerpt
- Digoxin extracted from the foxglove plant is a widely prescribed natural product for treating heart failure.
- Closing excerpt
- Identifying the foxglove P450scc is a crucial step toward completely elucidating digoxin biosynthesis and expanding the therapeutic applications of digoxin analogs in future work.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (150 words)
Digoxin extracted from the foxglove plant is a widely prescribed natural product for treating heart failure. It is listed as an essential medicine by the World Health Organization. However, how the foxglove plant synthesizes digoxin is mostly unknown, especially the cytochrome P450 sterol side chain cleaving enzyme (P450scc), which catalyzes the first and rate-limiting step. Here we identify the long-speculated foxglove P450scc through differential transcriptomic analysis. This enzyme converts cholesterol and campesterol to pregnenolone, suggesting that digoxin biosynthesis starts from both sterols, unlike previously reported. Phylogenetic analysis indicates that this enzyme arises from a duplicated cytochrome P450 CYP87A gene and is distinct from the well-characterized mammalian P450scc. Protein structural analysis reveals two amino acids in the active site critical for the foxglove P450scc's sterol cleavage ability. Identifying the foxglove P450scc is a crucial step toward completely elucidating digoxin biosynthesis and expanding the therapeutic applications of digoxin analogs in future work.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 37422531 · DOI · PMC10329713
Low-dose digoxin improves cardiac function in patients with heart failure, preserved ejection fraction and atrial fibrillation - the RATE-AF randomized trial [4]
Abstract reading summary — source excerpts
- Opening excerpt
- AimsTo compare the effect of digoxin versus beta-blockers on left ventricular function, in patients with permanent atrial fibrillation (AF) and symptoms of heart failure within the RATE-AF randomized trial.
- Closing excerpt
- There were no significant differences between groups for patients with LVEF 40-49% and ConclusionsLow-dose digoxin in patients with symptoms of heart failure, preserved LVEF and permanent AF leads to a significantly greater improvement in systolic function compared to treatment with beta-blockers.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (193 words)
AimsTo compare the effect of digoxin versus beta-blockers on left ventricular function, in patients with permanent atrial fibrillation (AF) and symptoms of heart failure within the RATE-AF randomized trial.Methods and resultsBlinded echocardiograms were performed at baseline and 12-month follow-up using a pre-defined imaging protocol and the index-beat approach. The change in systolic and diastolic function was assessed, stratified by left ventricular ejection fraction (LVEF). Overall, 145 patients completed follow-up, with median age 75 years (interquartile range 69-82) and 44% women. In 119 patients with baseline LVEF ≥50%, a significantly greater improvement in systolic function was noted in patients randomized to low-dose digoxin versus beta-blockers: adjusted mean difference for LVEF 2.3% (95% confidence interval [CI] 0.3-4.2; p = 0.021), s' 1.1 cm/s (95% CI 1.0-1.2; p = 0.001) and stroke volume 6.5 ml (95% CI 0.4-12.6; p = 0.037), with no difference in global longitudinal strain (p = 0.11) or any diastolic parameters. There were no significant differences between groups for patients with LVEF 40-49% and ConclusionsLow-dose digoxin in patients with symptoms of heart failure, preserved LVEF and permanent AF leads to a significantly greater improvement in systolic function compared to treatment with beta-blockers.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 40891341 · DOI · PMC12803603
Key reviews and meta-analyses
The most cited review-type papers among PubMed’s best-match results for this heading, listed with bibliographic details only. Follow the links for the full text and access terms.
- Research article Safety and efficacy of digoxin: systematic review and meta-analysis of observational and controlled trial data [5]
- Research article Digoxin-associated mortality: a systematic review and meta-analysis of the literature [6]
- Research article Clinical pharmacokinetics of digoxin [7]
- Research article Meta-analysis of the effectiveness of prophylactic drug therapy in preventing supraventricular arrhythmia early after coronary artery bypass grafting [8]
- Research article Contemporary use of digoxin in the management of cardiovascular disorders [9]
- Research article Digoxin [10]
References
- Wang C, Niederstrasser H, Douglas PM, Lin R, Jaramillo J, Li Y, et al.. Small-molecule TFEB pathway agonists that ameliorate metabolic syndrome in mice and extend C. elegans lifespan. . 2017. PMID 29273768 · DOI · PMC5741634
- Cho J, Lee YJ, Kim JH, Kim SI, Kim SS, Choi BS, et al.. Antiviral activity of digoxin and ouabain against SARS-CoV-2 infection and its implication for COVID-19. . 2020. PMID 33004837 · DOI · PMC7530981
- Carroll E, Ravi Gopal B, Raghavan I, Mukherjee M, Wang ZQ. A cytochrome P450 CYP87A4 imparts sterol side-chain cleavage in digoxin biosynthesis. . 2023. PMID 37422531 · DOI · PMC10329713
- Bunting KV, Champsi A, Gill SK, Saadeh K, Camm AJ, Stanbury M, et al.. Low-dose digoxin improves cardiac function in patients with heart failure, preserved ejection fraction and atrial fibrillation - the RATE-AF randomized trial. . 2025. PMID 40891341 · DOI · PMC12803603
- Ziff OJ, Ziff OJ, Lane DA, Samra M, Griffith M, Kirchhof P, et al.. Safety and efficacy of digoxin: systematic review and meta-analysis of observational and controlled trial data. BMJ. 2015. PMID 26321114 · DOI · PMC4553205
- Vamos M, Erath JW, Hohnloser SH. Digoxin-associated mortality: a systematic review and meta-analysis of the literature. Eur Heart J. 2015. PMID 25939649 · DOI
- Iisalo E. Clinical pharmacokinetics of digoxin. Clin Pharmacokinet. 1977. PMID 322907 · DOI
- Kowey PR, Taylor JE, Rials SJ, Marinchak RA. Meta-analysis of the effectiveness of prophylactic drug therapy in preventing supraventricular arrhythmia early after coronary artery bypass grafting. Am J Cardiol. 1992. PMID 1347966 · DOI
- Gheorghiade M, van Veldhuisen DJ, Colucci WS. Contemporary use of digoxin in the management of cardiovascular disorders. Circulation. 2006. PMID 16735690 · DOI
- Eichhorn EJ, Gheorghiade M. Digoxin. Prog Cardiovasc Dis. 2002. PMID 12007081 · DOI
About this article
- Sources
- NLM Medical Subject Headings (definition, synonyms); NCBI PubMed (counts, identifiers); Europe PMC (open-access abstracts and citation counts).
- Verification
- Every reference was resolved against PubMed on 2026-10-31; title, year and DOI matched.
- Review state
- automated source verified; no human expert review has been recorded yet.
- Version
- 1, last updated 2026-10-31.
See how EvidenceLib is built. Spotted an error? Email support@evidencehelix.com.
Evidence strength
EvidenceHelix's computed view of the study designs behind this topic: how common meta-analyses, randomized trials and reviews are, how recent the literature is, and a plain-language reading. It describes the design mix of the literature. It is not a quality appraisal of any study, and it is not medical advice.