Licorice (Glycyrrhiza glabra), Figure 1 is a herb that has been used for centuries in traditional medicine due to its various biological activities.Digoxin is a cardiac glycoside that works by inhibiting the sodium-potassium ATPase pump, leading to increased intracellular calcium levels and enhanced cardiac contractility.Glycyrrhizin has been found to possess several pharmacological properties, including anti-inflammatory, antiviral, antioxidant, and hepatoprotective effects
However, the prolonged or excessive use of licorice, especially in the form of supplements or extracts, can lead to a condition called licorice-induced hypokalemia.Hypokalemia can potentiate the toxic effects of digoxin, as low potassium levels impair the function of the sodium-potassium ATPase pump, leading to increased intracellular sodium levels and enhanced digoxin toxicity.[1]

The mechanism by which licorice induces hypokalemia involves the inhibition of an enzyme called 11-beta-hydroxysteroid dehydrogenase type 2 (11?-HSD2).This imbalance in electrolyte levels can result in hypokalemia.[3]