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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
- 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.
Last reviewed 01/2018