Digoxin for rate control of atrial fibrillation
Digoxin is not a first-line drug for the treatment of atrial fibrillation because it may not control exercise-induced tachycardia when used aloneHindricks, 2021. It is a useful addition:
- if beta blockers or nondihydropyridine calcium channel blockers do not control heart rate
- in patients with both atrial fibrillation and heart failure in whom other drugs are contraindicated or may need to be introduced very slowly (eg beta blockers).
A suitable digoxin regimen for long-term rate control is:
digoxin 62.5 to 250 micrograms orally, once daily, depending on age, body weight and kidney functionHindricks, 2021. digoxin digoxin digoxin
Monitor plasma digoxin concentration in patients who require a high dose, older patients and patients with kidney impairment. Avoid concentrations above 1.2 micrograms/L to minimise the risk of toxicityNHFA CSANZ Atrial fibrillation guideline working group, 2018.