NutriStack
Digoxin and Psyllium Husk, timing-sensitive.
Psyllium husk is a bulk-forming fiber similar to ispaghula, which has reduced digoxin bioavailability in human studies. Taking psyllium close to digoxin can lower digoxin exposure and may reduce heart rate or heart failure control. The risk is highest when fiber timing changes suddenly in older adults or people maintained near the low end of the therapeutic range.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
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At a glance
- Substances
- Digoxin and Psyllium Husk
- Pair type
- Timing Sensitive
- Evidence (highest tier)
- Moderate
- Source citations
- 2 sources
- Stack Score effect
- −5 to your Stack Score (per scored timing-sensitive row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Timing Sensitive · Moderate evidence
Timing Sensitive
What is happening. Psyllium husk is a bulk-forming fiber similar to ispaghula, which has reduced digoxin bioavailability in human studies. Taking psyllium close to digoxin can lower digoxin exposure and may reduce heart rate or heart failure control. The risk is highest when fiber timing changes suddenly in older adults or people maintained near the low end of the therapeutic range.
Mechanism. Gel-forming fiber can trap or adsorb digoxin in the intestinal lumen and change transit, reducing the amount available for absorption. Consistent separation lowers the chance of a clinically meaningful drop in exposure.
Recommendation. Take psyllium husk at least 4 hours away from digoxin and keep your fiber routine consistent from day to day. Tell your prescriber if you start or stop daily psyllium, because symptoms or digoxin levels may need monitoring.
Minimum separation. 240
Sources (2)
- Nordstrom M, Melander A, Robertsson E, Steen B. Influence of wheat bran and of a bulk-forming ispaghula cathartic on the bioavailability of digoxin in geriatric in-patients. Drug Nutr Interact. 1987;5(2):67-69. PMID 3038494
- Reissell P, Manninen V. Effect of administration of activated charcoal and fibre on absorption, excretion and steady state blood levels of digoxin and digitoxin. Evidence for intestinal secretion of the glycosides. Acta Med Scand Suppl. 1982;668:88-90. PMID 6963097
Stack Score
How this pair moves the number.
Effect on the composite score
If both Digoxin and Psyllium Husk are in the same stack, this pair applies −5 to your Stack Score (per scored timing-sensitive row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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