Cautions and contraindications

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.