Mild-to-moderate heart failure (with a diuretic and an ACE inhibitor when possible). Control of ventricular response rate in chronic atrial fibrillation.
Individualize: see literature. Initially 0.003mg/kg per day. Monitor digoxin levels.
Individualize: see literature. >2yrs: initially 0.01mg/kg per day. Monitor digoxin levels.
Renal dysfunction: reduce dose. Sinus node disease. Incomplete AV block. Accessory AV pathway (Wolff-Parkinson-White syndrome). Heart failure with preserved LV ejection fraction (eg, restrictive cardiomyopathy, constrictive pericarditis, amyloid heart disease, acute cor pulmonale, hypertrophic cardiomyopathy). Electrical cardioversion. Acute MI. Toxicity risk increased by hypokalemia, hypomagnesemia, hypercalcemia, diabetes. Hypocalcemia may nullify effects. Thyroid disease. Hypermetabolic states. Monitor digoxin levels, electrolytes, renal function. Elderly. Children. Infants. Pregnancy (Cat.C). Nursing mothers.
May be potentiated by antiarrhythmics (amiodarone, propafenone, quinidine), calcium channel blockers (verapamil, diltiazem, nifedipine, nitrendipine), captopril, telmisartan, spironolactone, carvedilol, epoprostenol, diclofenac, indomethacin, tramadol, ketoconazole, itraconazole, rabeprazole, clarithromycin. May be antagonized by rifampin, acarbose, miglitol, cyclosporine, colestipol, St. John's Wort, albuterol. Increased risk of arrhythmias with sympathomimetics. Others (see literature).
GI upset, anorexia, CNS effects (eg, blurred or yellow vision, or mental disturbances, confusion, headache, weakness, dizziness, apathy), gynecomastia, rash, heart block, arrhythmias (esp. children).