effect, digoxin increases the cardiac muscular force of contraction. However, if alternative treatments are not appropriate, digoxin can be used to control the ventricular rate in patients with cardiac amyloidosis and atrial fibrillation.Digoxin can rarely precipitate vasoconstriction and therefore should be avoided in patients with myocarditis.Patients with beri-beri heart disease may fail to respond adequately to digoxin if the underlying thiamine deficiency is not treated concomitantly.Digoxin should not be used in constrictive pericarditis unless it is used to control the ventricular rate in atrial fibrillation or to improve systolic dysfunction.Digoxin improves exercise tolerance in patients with impaired left ventricular systolic dysfunction and normal sinus rhythm. administration to healthy volunteers, between 60 and 75 % of a digoxin dose is recovered unchanged in the urine over a six day follow-up period. Patients who receive digoxin antibody fragment should be monitored for changes in serum potassium level, creatinine level, vital signs, heart failure symptoms, and electrocardiography findings. For details, consult the literature supplied with antibody fragments.Pharmacotherapeutic group: Cardiac therapy, cardiac glycosides, digitalis glycosides.Digoxin increases contractility of the myocardium by direct activity. This effect is proportional to dose in the lower range and some effect is achieved with quite low dosing; it occurs even in normal myocardium although it is then entirely without physiological benefit. Direct current cardioversion is inappropriate in the treatment of arrhythmias thought to be caused by cardiac glycosides.Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take digoxin.These may arise from effects on the renal excretion, tissue binding, plasma protein binding, distribution within the body, gut absorptive capacity, P-glycoprotein activity and sensitivity to digoxin. 5,6 It follows a two-compartment kinetic model with an initial distribution phase into the central compartment consisting primarily of plasma and highly perfused tissues, such as the liver. • hypersensitivity to the active substance, other digitalis glycosides or to any of the excipients listed in section 6.1.Patients receiving digoxin should have their serum electrolytes and renal function (serum creatinine concentration) assessed periodically; the frequency of assessments will depend on the clinical setting.Serum concentrations of digoxin may be expressed in Conventional Units of nanograms/ml or SI Units of nanomol/l. Anorexia, nausea and vomiting have been reported with an incidence up to 80 %. More patients in the rhythm-control group than in the rate-control group were hospitalised, and there were more adverse drug effects in the rhythm-control group as well. Serum digoxin concentrations should be monitored and used for titration of digoxin.The concomitant use of digoxin and sennosides may be associated with a moderate increase in the risk of digoxin toxicity in heart failure patients.Patients receiving digoxin are more susceptible to the effects of suxamethonium-exacerbated hyperkalaemia.Co-administration of lapatinib with orally administered digoxin resulted in an increase in the AUC of digoxin. Adverse drug reactions identified through post-marketing surveillance were considered to be rare or very rare (including isolated reports).Arrhythmia, conduction disorder, bigeminy, trigeminy, PR prolongation, sinus bradycardiaSupraventricular tachyarrhythmia, atrial tachycardia (with or without block), supraventricular tachycardia (nodal arrhythmia), ventricular arrhythmia, ventricular extrasystoles, electrocardiogram ST segment depressionGeneral disorders and administration site conditionsSkin rashes of urticarial or scarlatiniform character may be accompanied by pronounced eosinophilia.Gynaecomastia can occur with long term administration.Reporting suspected adverse reactions after authorisation of the medicinal product is important. Nifedipine and diltiazem may increase or have no effect on serum digoxin levels while isradipine causes no change. Co-administration with diuretics such as loop or hydrochlorothiazide should be under close monitoring of serum electrolytes and renal function.Calcium, particularly if administered rapidly by the I.V. Br Heart J. In complete heart block the idioventricular escape rhythm may be suppressed.In some cases of sinoatrial disorder (i.e. Following I.V. This result corresponds with previous studies. There were 356 deaths among the patients assigned to rhythm-control therapy (amiodarone, disopyramide, flecainide, moricizine, procainamide, propafenone, quinidine, sotalol, and combinations of these drugs) and 310 deaths among those assigned to rate-control [β-blockers, calcium-channel blockers (verapamil and diltiazem), digoxin, and combinations of these drugs) therapy (mortality at five years, 23.8% and 21.3%, respectively; hazard ratio, 1.15 [95% confidence interval, 0.99 to 1.34]; p=0.08).