Cardiac glycosides should be used with caution in:
- recent myocardial infarction
- constrictive pericarditis - for a similar reason
- hypothyroidism - decreased efficacy and increased risk of toxicity
- chronic cor pulmonale - decreased efficacy and increased risk of toxicity
- elderly - smaller doses needed
- renal impairment - smaller doses needed
- avoid hypokalaemia
- avoid rapid intravenous administration
Contraindications include:
- arrythmias associated with accessory conduction pathways (e.g. Wolff-Parkinson-White syndrome) - these drugs should not be used to treat these sorts of arrythmia because they will impair conduction through the normal conducting pathway without affecting the accessory pathways
- intermittent complete heart block, second degree AV block
- left ventricular outflow obstruction (e.g. HOCM, aortic stenosis) increase force of contraction against an obstruction - occasionally digoxin may be used if concomitant atrial fibrillation and heart failure - consult expert advice on management in this situation
Note that digoxin interacts significantly with many drugs.
The summary of product characteristics should be consulted before prescribing this drug.