The Massachusetts General Hospital Handbook of Neurology

Authors: Flaherty, Alice W.; Rost, Natalia S.

Title: Massachusetts General Hospital Handbook of Neurology, The, 2nd Edition

Copyright 2007 Lippincott Williams & Wilkins

> Table of Contents > Drugs > Digoxin

Digoxin

A. Elimination

Renal. However, digoxin cannot be dialyzed off.

B. Drug interactions

Cut digoxin dose in half when you start verapamil, quinidine, or amiodarone; check frequent levels.

C. Overdose

(Note: digoxin level must be drawn >6 h after dose.):

• Signs: Vomiting, diarrhea, diplopia, yellow-haloed vision, confusion, low KCl. Long PR interval, heart block, junctional tach., V tach., and V fib. Bidirectional V tach. is pathognomonic for digoxin toxicity.

• Rx: Cardiac monitor, stop digoxin; replete KCl, Mg, and Ca; lidocaine for V tach./V fib. If heart block, pace. Digibind only if serious arrhythmia.