Quick facts
| Fact | Digoxin |
|---|---|
| Drug class[1][2] | Cardiac glycoside |
| Used for[2] | Mild to moderate heart failure in adults; increasing heart contractility in children with heart failure; and, in adults with chronic atrial fibrillation, control of the ventricular rate at rest |
| Main safety warning[2] | Toxic blood levels sit only slightly above therapeutic levels. Toxicity shows up as nausea, vomiting, vision changes and arrhythmias |
| Check before each dose[1][2] | Apical pulse for a full minute; potassium, digoxin level and kidney function as ordered |
| Level linked to toxicity[1][2] | Usually above 2 ng/mL, though symptoms can start at lower levels |
| Antidote[1][2] | Digoxin immune fab (DigiFab), for life-threatening toxicity |
| High-alert status[3] | IV digoxin is on the ISMP high-alert list |
Before giving digoxin: a full-minute apical pulse and a potassium check
- Count the apical pulse for one full minute before every dose. Open RN teaches withholding the dose and notifying the prescriber if it is under 60/min. Parameters are often written into the order, so follow the ones there.[1]
- Check the potassium. Low potassium increases digoxin's effect and can cause toxicity, and Open RN says to report a result under 3.5 mEq/L to the provider right away.[1]
- Low magnesium, high calcium, low body weight, older age and impaired kidney function may also predispose the patient to toxicity.[2]
- Review the serum digoxin level when it's ordered. It's drawn right before the next dose, or 6 or more hours after the last one, and the label says to interpret it in the overall clinical picture.[2]
- Flag drugs that raise digoxin levels, such as quinidine, ritonavir, amiodarone and verapamil. Beta blockers and calcium channel blockers add to digoxin's slowing of AV conduction and can cause bradycardia or heart block.[2]
Report nausea, vision changes or a new rhythm as possible toxicity
- Stomach symptoms often come first. Nausea, vomiting and loss of appetite are very common in toxicity, and in most published reports they show up before rhythm changes in about half of patients.[2]
- Vision changes include blurred vision, halos, and colors that look yellow or green.[1][2]
- Rhythm changes include new bradycardia, heart block, extra ventricular beats (especially bigeminy or trigeminy) and ventricular tachycardia.[1][2]
- Confusion, weakness, dizziness and headache can also occur.[2]
- In infants and children, the first sign is often a new arrhythmia, such as sinus bradycardia.[2]
- Heart failure and digoxin toxicity share symptoms, so when the cause isn't clear, the label calls for a serum digoxin level.[2]
- For life-threatening toxicity, the prescriber may order digoxin immune fab (DigiFab), which binds digoxin and lowers the free drug. Its common effects include hypokalemia and worsening heart failure.[1]
Teach the patient to track the pulse and call about toxicity signs
- Check and write down heart rate and blood pressure every day.[2]
- Report a pulse under 60/min.[1]
- Call the health care provider about nausea, vomiting, ongoing diarrhea, confusion, weakness or any vision change.[2]
- Take it at the same time each day, never double up, and call the provider if two or more doses are missed.[1]
- Keep it in its original container, apart from other medicines.[1]
The app's clinical tools include drug references for digoxin and furosemide and a potassium lab reference.
Browse clinical toolsHow it shows up on nursing exams
- Before giving digoxin, the assessments are a full-minute apical pulse, the potassium and the digoxin level.[1]
- Digoxin plus furosemide is the combination to watch, because furosemide lowers potassium and hypokalemia raises the risk of digoxin toxicity.[1]
- Nausea plus a yellow-green vision change in a patient on digoxin is a toxicity cue that gets reported.[1][2]
Practice question
A 78-year-old patient with heart failure and chronic atrial fibrillation takes digoxin and furosemide at home. On the medical-surgical unit, the patient reports nausea and no appetite since yesterday and says the lights look yellow-green. Apical pulse is 54/min, blood pressure 108/66 mm Hg and potassium 3.1 mEq/L. Which action should the nurse take first?
- A. Give the digoxin and recheck the apical pulse in 1 hour
- B. Withhold the digoxin and notify the health care provider
- C. Request a prescription for an antiemetic for the nausea
- D. Give the furosemide and encourage potassium-rich foods
Show the answer and why
Correct answer: B. Withhold the digoxin and notify the health care provider
- A. Incorrect. More digoxin adds to the problem. The pulse is already under 60/min, where Open RN teaches withholding the dose, and the symptoms point to toxicity.
- B. Correct. Nausea, loss of appetite and yellow-green vision point to possible toxicity, the pulse is under 60/min, and a potassium of 3.1 mEq/L raises the risk further. Withholding the dose and reporting follows Open RN's teaching, and the label calls for a digoxin level when toxicity is suspected.
- C. Incorrect. Treating the nausea alone misses its likely cause. Nausea, vomiting and loss of appetite are among the most common signs of digoxin toxicity.
- D. Incorrect. Giving a loop diuretic when potassium is already low can worsen hypokalemia and cause a life-threatening arrhythmia, and low potassium raises the risk of digoxin toxicity.
Sources for this question: [1][2]
Memory hook: Digoxin check: full-minute apical pulse, potassium, and ask about yellow-green vision.