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Digoxin has a narrow therapeutic indexincreased monitoring of serum digoxin concentrations and for potential signs and symptoms of clinical toxicity is necessary when initiatingadjustingor discontinuing drugs that may interact with digoxinPrescribers should consult the prescribing information of any drug which is co-prescribed with digoxin for potential drug interaction information.

Hypocalcemia can nullify the effects of digoxin in humansthusdigoxin may be ineffective until serum calcium is restored to normalThese interactions are related to the fact that digoxin affects contractility and excitability of the heart in a manner similar to that of calcium.

If you are taking Lanoxin and suxamethoniumused to help muscle relaxation and treat short-term paralysisyou may have an increased risk of high potassium levels in the blood

It may be desirable to reduce the dose of or discontinue digoxin for 1 to 2 days prior to electrical cardioversion of atrial fibrillation to avoid the induction of ventricular arrhythmiasbut physicians must consider the consequences of increasing the ventricular response if digoxin is decreased or withdrawnIf digitalis toxicity is suspectedelective cardioversion should be delayedIf it is not prudent to delay cardioversionthe lowest possible energy level should be selected to avoid provoking ventricular arrhythmias.

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