Digoxin (Lanoxin) is a cardiac glycoside. It makes the heart squeeze harder and slows the heart rate. It shows up on almost every pharmacology exam.
What it is used for
- Heart failure
- Controlling heart rate in atrial fibrillation
Before you give it
- Count the apical pulse for a full minute.
- Hold it and notify the provider if an adult's apical pulse is below 60. Children and infants have higher limits, so follow the order and your facility's policy.
- Check the potassium. Low potassium makes digoxin toxicity much more likely.
- Check kidney function. Digoxin leaves the body through the kidneys, so poor kidney function raises the level.
Signs of toxicity
- Nausea, vomiting, and loss of appetite (often the first signs)
- Vision changes: blurred vision or yellow-green halos around lights
- Confusion or weakness
- Slow heart rate or new irregular rhythms
Labs to know
| Lab | Typical target |
|---|---|
| Digoxin level | About 0.5 to 2.0 ng/mL (lower targets are often used in heart failure) |
| Potassium | 3.5 to 5.0 mEq/L |
Antidote
Digoxin immune fab (DigiFab) is used for serious toxicity.
Patient teaching
- Take it at the same time every day. Do not double up if you miss a dose.
- Check your pulse before each dose if your provider asks you to.
- Report nausea, vision changes, or a slow pulse right away.
- Ask before taking new medicines or supplements, including antacids and herbal products.
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Quick answers
When should the nurse hold digoxin?
Hold digoxin and notify the provider if an adult's apical pulse is below 60 beats per minute, or as directed by the order.
What are the signs of digoxin toxicity?
Nausea, vomiting, loss of appetite, vision changes such as yellow-green halos, confusion, a slow heart rate, and new irregular rhythms.
Evidence & Clinical Sources
- DailyMed FDA drug labels
- Vallerand & Sanoski, Davis's Drug Guide for Nurses, F.A. Davis
- 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure
Reviewed against current guidelines and drug labels. Always follow your program, a current drug reference, and facility policy. Our sources policy
For learning only. Lab ranges and policies vary. Always follow your nursing program, a current drug reference, and your facility's policies.