Arrhythmias

Drug level monitoring of digoxin is recommended because it has a narrow therapeutic index and therefore should be used with caution in the elderly and in renal impairment. Therapeutic concentrations of digoxin are quoted as 0.8 - 2.2 micrograms/L, but results should be interpreted alongside clinical findings and serum potassium levels. Measurement of digoxin levels should be taken at least 6 hours post dose. See local Therapeutic Drug Monitoring Guidance.

Patients are at an increased risk of digoxin toxicity if hypokalaemia occurs.

Administration route: when changing from tablets to elixir, ONE 62.5micrograms tablet is approximately equivalent to 50micrograms(1mL) elixir.

Amiodarone requires careful monitoring. See BNF for cautions, side effects, interactions and monitoring.

Dronedarone is a derivative of amiodarone. It must be used second line to other anti-arrhythmic agents including amiodarone. See BNF for cautions, side effects, interactions and monitoring. There is a shared care guideline for prescribing.