Cardiology · Cardiac glycoside
Digoxin
Dose
Loading 500 mcg PO stat, 250 mcg 6 h later, 250 mcg 6 h later; then 62.5–250 mcg OD. IV load 500 mcg over 30 min.
Mechanism
Inhibits Na/K-ATPase → ↑intracellular Ca → positive inotropy + vagal tone.
Indications
- • Rate control in AF (esp with HF)
- • HFrEF symptoms despite standard therapy
Contraindications
- • Complete heart block
- • WPW with AF
- • HOCM with outflow obstruction
- • VF/VT
Dose adjustment
CrCl <30: halve maintenance; elderly: 62.5 mcg OD
Use
Adjunct for rate control in AF with HF; symptom relief in HFrEF.
Monitoring
Digoxin level (0.5–0.9 ng/mL in HF) 6 h post-dose; U&E, Mg, Ca.
Side effects
- • Toxicity: nausea, xanthopsia, arrhythmias (AV block, VT)
- • Bradycardia
Pregnancy safety
Safe.
Related in WardRound
Always confirm dose against your local formulary / BNF before prescribing.
