Digoxin Toxicity

Clinical Manifestations of Digoxin Toxicity:

  • Generally unwell
  • Lethargy, Nausea/Vomiting, confusion, yellow-green vision
  • Arrhythmias (e.g. AV block, bradycardia, VF, VT)
  • Acute toxicity has predominant GI symptoms and chronic has predominant CNS symptoms
  • Atrial tachycardia with AV block is the most common arrhythmia caused by digoxin

Precipitating factors

  • Classically: hypokalemia
  • Myocardial ischemia
  • Hypomagnesemia, hypercalcemia, hypernatremia, acidosis
  • Hypoalbuminemia
  • Hypothermia
  • Hypothyroidism
  • Drugs: amiodarone, quinidine, verapamil, spironolactone (compete for secretion in the distal convoluted tubule, therefore, reduce excretion)

Management of Digoxin Toxicity

  • Withdrawal of digitalis, potassium supplements
  • Correct arrhythmias and use digitalis antibody (fab fragments) for digoxin toxicity.
  • Monitor the Potassium level.
  • It is recommended that the digoxin dose be decreased by 25%-50% when initiating amiodarone therapy, with close monitoring of digoxin levels once weekly for the next several weeks
Digoxin Toxicity


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