What is the therapeutic serum digoxin level for different indications?

HFrEF: target 0.5-0.9 ng/mL (mortality benefit at low levels; harm at higher levels); AF rate control: 0.8-2.0 ng/mL; sample ≥6h post-dose; levels may differ from older texts that targeted 0.8-2.0 for HF.

How is the maintenance digoxin dose calculated for renal impairment?

Digoxin clearance = (CrCl × 1.303) + 40; maintenance dose = Cl_digoxin × target_level / F (F=0.75 oral); doses require reduction proportional to CrCl reduction; never use in severe renal failure without TDM.

What are signs of digoxin toxicity?

GI symptoms (nausea, anorexia, vomiting) typically precede cardiac toxicity; visual changes (yellow-green chromatopsia, halos); cardiac: bradycardia, AV block, bidirectional VT (pathognomonic), atrial tachycardia with block.

How is digoxin Fab (Digibind/DigiFab) dosed for acute toxicity?

Based on steady-state level: vials = (serum level ng/mL × weight kg) / 100; based on ingested dose: vials = (dose in mg × 0.8) / 0.5; minimum 2 vials for empiric dosing; complete reversal typically with 10-20 vials in acute massive ingestion.

Which drugs require digoxin dose adjustment?

Amiodarone, quinidine, verapamil, diltiazem, and carvedilol increase digoxin levels significantly (reduce dose 50%); spironolactone may falsely elevate digoxin immunoassay; rifampin reduces digoxin absorption.

Digoxin Dosing and Toxicity Monitoring Calculator

Calculates digoxin loading dose, maintenance dose based on lean body weight and CrCl, target serum level by indication (AF rate control vs HFrEF), and Fab fragment antidote dosing for toxicity.

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Frequently Asked Questions

What is the therapeutic serum digoxin level for different indications?

How is the maintenance digoxin dose calculated for renal impairment?

What are signs of digoxin toxicity?

How is digoxin Fab (Digibind/DigiFab) dosed for acute toxicity?

Which drugs require digoxin dose adjustment?