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Atrial fibrillation - Management
What dose of digoxin should I prescribe and how should the dose be titrated?
- Prescribe a loading dose of 250 micrograms to 500 micrograms daily for 1–2 days, followed by a maintenance dose.
- A clinical response is usually seen within 1 week.
- Seek specialist advise for people who are elderly and who have renal impairment. The loading dose of digoxin will need to be reduced.
- The usual maintenance dose is 62.5 micrograms to 250 micrograms daily; this is adjusted according to the heart rate response.
- Check the person's pulse rate and apical rate 1 week after initiation and after any change in dose.
Clarification / Additional information
- A more rapid response may be achieved by prescribing 1–1.5 mg in divided doses over 24 hours [BNF 57, 2009], although CKS expert reviewers suggest that usually no more than 1000 micrograms (1 mg) is needed in 24 hours.
- If a more rapid clinical response is required, consider referral to secondary care.
Basis for recommendation
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