2.1.1 Cardiac glycosides

General guidance

• Cardiac glycosides are most useful in the treatment of supraventricular tachycardia, especially for controlling ventricular response in atrial fibrillation.
• For maintenance of atrial fibrillation the dose should be adjusted so that the ventricular rate at rest should not normally be allowed to fall below 60 beats per minute, except in special cases.
• Renal function is an important determinant of digoxin dosage, care needs to be taken to adjust the dose in cases of renal impairment.
• Heart Failure: digoxin has been widely used in the management of heart failure in the UK. However, it should now be reserved for those with atrial fibrillation or those with moderate to severe heart failure who remain symptomatic despite treatment with a diuretic, an ACE inhibitor and a beta-blocker.
• Regular monitoring of plasma concentrations is not necessary unless toxicity is suspected.

Recommended drugs

Digoxin £

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low