Toxicity within the therapeutic range
Toxicity is more likely within the therapeutic range if:
- hypokalaemia and hypomagnesaemia (separately or in combination) - favour ectopic rhythms
- hypercalcaemia - calcium has similar cardiac effects to digoxin
- hyperkalaemia - promotes A-V block
- plasma creatinine greater than 150 micromol/l
- age greater than 60 years
- daily maintenance dose greater than 6 micrograms/kg - for example, 365 micrograms for 60 kg patient
- the patient has hypoxaemic acidaemia
- the patient is hypothyroid
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