Uses

Used in the treatment of heart failure with reduced ejection fraction and rate control in atrial fibrillation and atrial flutter. Helps improve cardiac output and reduces ventricular rate.

Do not use if

Contraindicated in patients with ventricular fibrillation, known hypersensitivity to digoxin, and in the presence of Wolff-Parkinson-White syndrome with accessory pathways. Use with extreme caution in hypokalemia, hypomagnesemia, and hypercalcemia.

Side effects

Common side effects include nausea, vomiting, anorexia, and fatigue. Toxicity (digoxin toxicity) can cause bradycardia, heart block, ventricular arrhythmias, and visual disturbances such as yellow-green halos. Hypokalemia increases the risk of toxicity.

Warnings

Has a narrow therapeutic index; monitor serum digoxin levels and electrolytes regularly. Hypokalemia, hypomagnesemia, and hypercalcemia increase the risk of toxicity. Renal impairment requires dose reduction. Many drug interactions can alter digoxin levels; review all concurrent medications.

How it works

Digoxin inhibits the Na+/K+-ATPase pump in cardiac cell membranes, increasing intracellular sodium and secondarily increasing intracellular calcium via Na+/Ca2+ exchange, thereby enhancing myocardial contractility (positive inotropic effect). It also slows conduction through the AV node via vagotonic effects.

Storage

Store at controlled room temperature between 15–30°C, protected from light and moisture.