Digoxin has a narrow therapeutic window, and toxicity can follow a fall in kidney function, hypokalaemia or a new interacting drug. Symptoms are often non-specific: nausea, anorexia, confusion, visual disturbance and arrhythmia.
In anyone on digoxin who presents acutely unwell, check the serum level, potassium and creatinine, and review recent additions such as amiodarone, verapamil or a diuretic. Take the sample at least six hours after the last dose so the level is interpretable. Treat the clinical picture, not the number alone, because toxicity can occur within the usual range, particularly with low potassium.
- Check digoxin level, potassium and creatinine together.
- Sample at least six hours after the last dose.
- Review new interacting drugs, including amiodarone and verapamil.
- Correct hypokalaemia; do not rely on the level alone.
Why it matters
Digoxin toxicity is often missed because its symptoms look like everything else.
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