Atrial Fibrillation (AF) – Persistent

Digoxin dosing guidance

Digoxin has a limited role as first-line treatment for rate control. It is usually used second-line in combination with a beta-blocker or calcium-channel blocker.

In frail elderly patients or patients with very low body weight, lower loading and maintenance doses than those advised below may be required. If further advice is required then contact your clinical pharmacist, or Medicines Information (see Appendix 6 for contact details) or out-of-hours the on-call pharmacist.

Loading dose – normal renal function:

• Digoxin oral (preferred route) 500micrograms followed 6 hours later by 500–1000micrograms in divided doses > 6 hours apart or
• Digoxin IV 500micrograms followed 6 hours later by 250–500micrograms in divided doses 4–6 hours apart.

Loading dose – renal impairment (creatinine clearance <30ml/minute):

• Digoxin oral (preferred route) 500micrograms followed 6 hours later by 250–375micrograms in divided doses >6 hours apart or
• Digoxin IV 250–500micrograms

N.B. Digoxin injection: 25micrograms = 0.1ml. Additional loading doses may be required; give according to ventricular (heart rate) response.

Maintenance daily dose: The tables below outline digoxin daily maintenance dosing for patients <60kg (see table 2) and >60kg (see table 3).

Table 2 – Digoxin daily maintenance dose if <60kg

Table 3 – Digoxin daily maintenance dose if >60kg

Target concentration range: 0.5–2micrograms/L (6–24 hours after the dose)

Time to steady state: 5–10 days

Concentration increased by amiodarone, diltiazem, quinine, verapamil (see BNF for more details).