Digoxin

ATC code

C01AA05

Therapeutic class

Cardiac glycoside · Digitalis glycoside

Forms

oral tablet, oral solution, injection

Brand names

Digoxina Kern Pharma (ES) · Lanoxin (US) · Digoxine Nativelle (FR)

Overall confidence

medium

Regulatory sources consulted

aemps-cima-ft-34566
crediblemeds.org
pharmacist-clinical-knowledge
RxNorm rxcui 3407 ↗

Approved indications

Treatment of chronic heart failure where the principal problem is systolic dysfunction.
Treatment of atrial fibrillation for ventricular rate control.

Contraindications

Absolute

Complete or second-degree atrioventricular block, especially with a history of syncope (Stokes-Adams syndrome).
Ventricular tachycardia or ventricular fibrillation.
Wolff-Parkinson-White syndrome and concomitant atrial fibrillation.

Clinical warnings

Major warning · Digitalis toxicity: Narrow therapeutic index. Symptoms include nausea, vomiting, arrhythmias, and visual disturbances. Serum level monitoring is crucial. — AEMPS CIMA
Major warning · Electrolyte disturbances: Hypokalemia, hypomagnesemia, and hypercalcemia increase the risk of digoxin toxicity. Correct and monitor electrolytes. — AEMPS CIMA

Drug interactions

HighAmiodaroneC01BD01
Mechanism: Inhibition of the P-glycoprotein (P-gp) transporter and reduction of digoxin renal clearance, potentially doubling its serum levels.
Recommendation: Reduce digoxin dose by 30-50% when starting amiodarone. Monitor digoxin levels closely.
AEMPS CIMA
HighVerapamilC08DA01
Mechanism: Inhibition of the P-glycoprotein (P-gp) transporter, increasing absorption and reducing elimination of digoxin. Serum levels increase by 50-75%.
Recommendation: Reduce digoxin dose by 50% and monitor serum levels.
AEMPS CIMA
ModerateDiuretics (thiazides, loop)C03
Mechanism: Pharmacodynamic interaction. Diuretic-induced hypokalemia increases myocardial sensitivity to digoxin, increasing the risk of arrhythmias and toxicity without changing serum levels.
Recommendation: Monitor and maintain potassium levels in the normal range (e.g., > 4.0 mEq/L) in patients taking digoxin.
AEMPS CIMA

Adverse events

Common (≥1%)

nausea · vomiting · diarrhea · dizziness · headache · visual disturbances (blurred or yellow vision/xanthopsia)

Rare but serious

ventricular arrhythmias · heart block · intestinal ischemia · thrombocytopenia

Pregnancy and lactation

FDA category: C

Crosses the placenta. Use only if the benefit justifies the potential risk to the fetus. Excreted in breast milk in small amounts; generally considered compatible with breastfeeding with infant monitoring.