cautions and contraindications

Last reviewed 03/2023

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.