The short answer
Yes, there is evidence of an interaction. Glycyrrhizin in mulethi makes the body lose potassium, and so do common water pills such as hydrochlorothiazide. In a small study, 2 of 10 healthy volunteers developed low potassium while taking liquorice with hydrochlorothiazide. A 50-year-old woman on the same water pill developed low potassium and muscle breakdown after three weeks of eating black licorice sweets.
Low potassium matters most with digoxin, a heart medicine with a narrow margin of safety, because it makes digoxin toxicity more likely. The European Medicines Agency advises against using licorice with diuretics or digoxin. If you take either, tell your prescribing doctor before you take mulethi in any form, and ask whether your potassium should be checked.
Hydrochlorothiazide is sold in India as Aquazide, furosemide as Lasix, torsemide as Dytor, and digoxin as Lanoxin.
At a glance
| What was seen | How it may work | Direction | Evidence |
|---|---|---|---|
| Low potassium in 2 of 10 volunteers taking liquorice with hydrochlorothiazide[1] | Both cause the body to lose potassium | Potassium falls | Small clinical study |
| Low potassium, high blood pressure and muscle breakdown in a woman on hydrochlorothiazide who ate licorice sweets[2] | Severe salt and potassium disturbance | Muscle injury (rhabdomyolysis) | Case report |
| Digitalis toxicity and heart failure in an elderly man taking a licorice-containing herbal laxative[3] | Not established; only the title is available | Digoxin-type toxicity | Case report |
| Greater risk of digoxin toxicity when potassium is low[5][4] | Low potassium makes the heart more sensitive to digoxin | Heart rhythm problems | Theoretical by mechanism |
No listing is not a clearance. A missing interaction here never means a combination is safe.
The evidence, study by study
Crossover study in healthy volunteers, 2009 Small clinical study
Ten healthy volunteers ate 32 g of liquorice a day for two weeks, once alone and once with hydrochlorothiazide 25 mg a day. On the combination, potassium fell by 0.32 mmol/L, and 2 of the 10 developed low potassium in the first week and dropped out. Potassium did not change on liquorice alone. There was no period on hydrochlorothiazide alone, so the study cannot say how much of the fall was due to the liquorice.[1]
Case report, 2012 Case report
A 50-year-old woman taking hydrochlorothiazide ate one and a half bags of black licorice bites, made with 2% natural licorice, over three weeks. She came to hospital after four days of muscle aches and dark urine, with high blood pressure, low potassium and rhabdomyolysis, a breakdown of muscle tissue. The report cannot separate the part played by the licorice from that of the water pill.[2]
Case report, 2002 Case report
The title of this report describes heart failure from digitalis toxicity in an elderly man who was taking a Chinese herbal laxative containing licorice. There is no abstract and we could not open the full report, so the dose, blood levels and other ingredients are not known.[3]
What your doctor may watch for
- Potassium, and also magnesium and kidney function, which your doctor may check together.[4]
- If you take digoxin: your digoxin level and heart rhythm. Digoxin has a narrow therapeutic index.[5]
- Muscle aches or dark urine, which were the first signs in the 2012 case.[2]
What to tell your prescribing doctor
You can read this out, or show them this page:
“I am taking, or planning to take, mulethi (licorice) as a tea, powder, lozenge, sweet or cough product (name and how much) along with my water pill or digoxin. Licorice and some water pills can lower potassium, and low potassium can make digoxin toxicity more likely. Should my potassium be checked?”
Withheld until review
Questions people ask
Do licorice sweets and cough products count?
Yes. The 2012 case involved licorice sweets, not a supplement. Include any tea, sweet, lozenge or cough product with licorice in it when you tell your doctor what you take.[2]
Related
Mulethi (licorice) and blood pressure medicines
Glycyrrhizin in mulethi raises blood pressure and lowers potassium. It can work against blood pressure medicines, as a regulator and a case report show.
InteractionMulethi (licorice) and steroid medicines like prednisolone
Glycyrrhizin from mulethi slowed the clearance of prednisolone in six men. A European regulator advises against licorice with corticosteroids.
InteractionArjuna and digoxin
No study has looked at people taking arjuna with digoxin. In the lab, arjuna made one digoxin blood test read slightly low.
InteractionPunarnava and diuretics (water tablets)
Not studied in people. Punarnava increased urine output in rats, so it could add to a water tablet. Nobody has measured whether it does.
Sources
- Hukkanen J, Ukkola O, Savolainen MJ. Effects of low-dose liquorice alone or in combination with hydrochlorothiazide on the plasma potassium in healthy volunteers. Blood Press. 2009;18(4):192-195. PMID 19562574.
- Shah M, Williams C, Aggarwal A, Choudhry WM. Licorice-related rhabdomyolysis: a big price for a sweet tooth. Clin Nephrol. 2012;77(6):491-495. PMID 22595392.
- 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. 2002;98(4):218. PMID 12566654.
- European Medicines Agency, HMPC. European Union herbal monograph on Glycyrrhiza glabra L., G. inflata Bat., G. uralensis Fisch., radix. EMA/HMPC/108399/2024, revision 1, adopted 4 March 2026. Sections 4.4 and 4.5.
- Digoxin tablets, US prescribing information (DailyMed).
Updated 4 November 2026
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