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Atrial fibrillation - Management
What are the adverse effects of digoxin?
- Non-cardiac adverse effects are usually associated with overdose and include:
- Nausea, vomiting, and (less commonly) diarrhoea. Nausea in particular is indicative of overdose.
- Visual abnormalities (blurred or yellow vision).
- Central nervous system effects, such as weakness, dizziness, confusion, apathy, malaise, headache, depression, and psychosis.
- Cardiac adverse effects are usually associated with overdose, although electrolyte imbalances may predispose the person to cardiac adverse effects so that they occur even at therapeutic concentrations. They include various conduction and rhythm disturbances, such as:
- Sinoatrial and atrioventricular block.
- Premature ventricular contractions (resulting in bigeminy or trigeminy).
- PR prolongation and ST-segment depression.
Clarification / Additional information
- Digoxin has a narrow therapeutic window — there is only a small range of plasma concentrations between which the drug is ineffective because of underdosing and toxic because of overdosing. Adverse effects usually occur at serum concentrations above the upper limit of the therapeutic window, and they are dose-dependent. If significant adverse effects occur, serum levels of digoxin should be measured.
Basis for recommendation
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