Experiences with

Digoxin

Digoxin is a type of medicine called a cardiac glycoside.

It's used to control some heart problems, such as irregular heartbeats (arrhythmias) including atrial fibrillation.

It can also help to manage the symptoms of heart failure, usually with other medicines. It's normally recommended when these other medicines have not been enough to control your symptoms on their own.

It works by slowing down your heart rate and making your heart beat more strongly, which makes it easier for your heart to pump blood around your body.

Digoxin is only available on prescription.

It comes as tablets and as a liquid (sometimes called an elixir). It can also be given as an injection, but this is usually done in hospital.

Who can take digoxin

Most adults can take digoxin.

It's sometimes prescribed for children if a heart specialist recommends it.

Who may not be able to take digoxin

Digoxin is not suitable for some people. To make sure it's safe for you, check with your doctor before you start to take digoxin if you have:

• ever had an allergic reaction to digoxin or any other medicine
• serious heart problems such as cardiomyopathy, Wolff-Parkinson-White syndrome, heart block, pericarditis, myocarditis, or you have recently had a heart attack
• kidney problems
• an overactive thyroid (hyperthyroidism) or an underactive thyroid (hypothyroidism) – changes in how the thyroid works can affect how digoxin works
• stomach or bowel problems, such as Crohn's disease, or if you have had surgery on your bowel or stomach – these can affect how much digoxin gets into your body and may change the dose of digoxin you need
• lung disease or severe asthma
• a rare hereditary problem of galactose intolerance, including the Lapp lactase deficiency or glucose-galactose malabsorption
• beriberi disease (also known as thiamine deficiency)
• a low blood potassium or magnesium level, or a high blood calcium level

Dosage

The first time you take digoxin you may be asked to take several tablets (or amounts of liquid) as a single dose – this is called the initial dose.

Your doctor will do a blood test after the initial dose to see how it's worked for you. They'll then recommend a daily dose. Sometimes this will be split into doses to take throughout the day.

After the initial dose, the usual daily dose for adults and children over 10 years is 125 micrograms to 250 micrograms daily.

Doses are usually lower for older people and for people with kidney disease, as they may be more likely to get side effects.

For babies and children under 10 years old, the doctor will use your child's weight and age to work out the right dose for them.

How to take it

You can take digoxin with or without food, but it's best to take it at the same time each day.

Most people take it in the morning after breakfast. You'll usually take it once a day.

Swallow the tablets whole with a drink of water.

If you're using the liquid, it's important to measure your dose using the syringe (pipette) that comes with the medicine. If you do not have a syringe, ask a pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

Do not dilute the liquid.

How long to take it for

You'll usually need to take digoxin long term, even for the rest of your life.

Talk to your doctor if you want to stop taking it. Stopping suddenly can make your condition worse.

If you forget to take it

If you miss a dose of digoxin, leave out that dose and take your next dose at the usual time.

Do not take 2 doses to make up for a forgotten dose.

If you often forget doses, it may help to set an alarm to remind you.

A pharmacist can give you advice on other ways to remember your medicine. Let your doctor know too, as it may affect your heart.

If you take too much

The amount of digoxin that can lead to an overdose varies from person to person. Children and older people may be more affected by the effects of too much digoxin.

If you've taken more than your prescribed dose of digoxin, your doctor may ask you to have a blood test to see how much digoxin is in your blood and to check how well your kidneys are working.

You may also be asked to have an electrocardiogram (ECG) to see the effect on your heartbeat.

• you take more than your prescribed dose of digoxin

Go to 111.nhs.uk or call 111 . Call 111 if you're asking about a child under 5 years old.

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the digoxin packet or leaflet inside it, any remaining medicine, and any other medicines you take.

Common side effects

These common side effects of digoxin happen in more than 1 in 100 people. There are things you can do to help cope with them:

Talk to your doctor or pharmacist if the advice on how to cope does not help and these side effects bother you or last longer than a few days.

Tell your doctor if you have more than 2 of the common side effects – it means you could have too much digoxin in your blood.

It happens rarely, but some people have serious side effects after taking digoxin.

Call your doctor or call 111 now if you have more than 2 of the common side effects – it means you could have too much digoxin in your blood.

• you have a fast heart rate (palpitations), shortness of breath, feel dizzy or feel light-headed

It's possible to have a serious allergic reaction (anaphylaxis) to digoxin.

These are not all the side effects of digoxin. For a full list see the leaflet inside your medicines packet.

Digoxin and pregnancy

You can take digoxin during pregnancy under the supervision of a specialist.

It's important that your heart condition is treated during pregnancy. This will help to keep you and your baby well.

If your doctor recommends digoxin during your pregnancy, they'll prescribe the lowest dose that works for you. They may want to measure the level of digoxin in your blood by taking blood tests.

If you're trying to get pregnant or you're already pregnant, talk to your doctor about whether to continue taking digoxin. In most cases, they'll recommend that you keep taking it.

Digoxin and breastfeeding

If your doctor, health visitor or midwife says that your baby is healthy, you can take digoxin if you're breastfeeding.

It's important to continue taking digoxin to keep you well. Breastfeeding will also benefit both you and your baby.

Digoxin passes into breast milk in very small amounts. It has not been known to cause any side effects in breastfed babies.

Talk to your health visitor, midwife, doctor or pharmacist as soon as possible if you have any concerns about your baby. This includes if they're:

• not feeding as well as usual
• not putting on weight as you would expect
• seeming unusually pale or sleepy

Digoxin and fertility

There's no evidence that digoxin reduces fertility in men or women.

Speak to a pharmacist or your doctor if you're trying to get pregnant.

Cautions with other medicines

Some medicines can affect the way digoxin works or can increase the risk of side effects.

Tell your doctor if you're taking any other medicines, including:

• medicines used to treat an irregular heartbeat (arrhythmia), heart conditions or high blood pressure such as amiodarone, verapamil or diltiazem
• medicines that make you pee more (diuretics) such as furosemide
• medicines to treat bacterial or fungal infections, such as tetracycline, clarithromycin, erythromycin, rifampicin, trimethoprim or itraconazole
• medicines for arthritis, including ibuprofen, diclofenac, indomethacin, hydroxychloroquine or chloroquine
• medicines to treat HIV, such as atazanavir, darunavir, ritonavir or saquinavir

These are not all the medicines that can affect digoxin. Check the leaflet inside your medicines packet.

Some medicines that you can buy from a pharmacy or shop can also affect the way digoxin works.

Ask a pharmacist for advice before using antacids, kaolin (for stomach upsets) or laxatives (for constipation).

Do not take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen regularly without checking with your doctor first.

Mixing digoxin with herbal remedies or supplements

The herbal remedy St John's wort can affect how digoxin works. Tell a pharmacist or doctor if you're using this or thinking about using it.

There's not enough information to say that other complementary medicines, herbal remedies and supplements are safe to take with digoxin. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Related links

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