Digoxin Toxicity

What is Digoxin Toxicity

Digoxin toxicity, also called digoxin poisoning, is a condition that occurs when you have too much digoxin in your blood. Digoxin is a medicine that is used to help a weakened heart function properly.

Digoxin increases the strength of the heart muscle, helps to maintain a normal heart rhythm, and helps to remove excess water from the body.

When there is too much digoxin in the body, it acts like a poison (toxin). Digoxin toxicity can be life-threatening and must be treated in a hospital.

What are the causes?

Digoxin toxicity can be caused by taking too much digoxin (overdosing). Overdose can happen accidentally. Digoxin toxicity can also occur if you are taking the correct dosage of digoxin but there are other factors affecting the digoxin levels in your body, such as:

• Taking other medicines that interact badly with digoxin.
• Having low potassium or magnesium levels.
• Having reduced kidney function. This prevents digoxin from leaving your body at the normal speed.

What are the signs or symptoms?

Symptoms of this condition include:

• Confusion.
• Changes in your vision, such as:
  • Seeing the color yellow more than you normally do.
  • Blurred vision.
  • Increased sensitivity to light.
  • Seeing flashing lights.
• Irregular heartbeats (arrhythmias). These heartbeats may be too fast or too slow.
• Loss of appetite.
• Nausea or vomiting.
• Diarrhea.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• Blood tests to check your digoxin, potassium, and magnesium levels.
• An electrocardiogram (ECG). This is a test that records the electrical impulses of your heart.

How is this treated?

This condition is treated by lowering your digoxin levels. This must be done in the hospital. Your treatment will depend on whether the digoxin toxicity is of sudden onset because of overdose (acute) or more gradual onset (chronic). To lower your digoxin levels, your health care provider may:

• Give you a medicine that absorbs digoxin in the stomach (activated charcoal). The charcoal may be given to swallow or given through a tube that goes from your nose to your stomach (nasogastric tube).
• Perform gastric lavage. In this procedure, a tube is placed through your nose or mouth into your stomach. The tube is used to remove digoxin that has not been digested yet. It may also be used to put medicines directly into your stomach to help stop digoxin from being absorbed.
• Give you an injectable medicine called a digoxin-binding antibody.

Follow these instructions at home:

Lifestyle

• Limit alcohol intake to no more than 1 drink a day for nonpregnant women and 2 drinks a day for men. One drink equals 12 oz of beer, 5 oz of wine, or 1½ oz of hard liquor.
• Do notuse any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your health care provider.
• Tell your health care provider if you drink caffeine or alcohol, you smoke, or you use drugs. This may affect the way your digoxin medicine works.

Eating and drinking

• Follow instructions from your health care provider about eating or drinking restrictions.
• Talk to your health care provider about your diet. The amount of fiber that you eat may affect the way your digoxin medicine works.
• Drink enough fluid to keep your urine clear or pale yellow.

General instructions

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• If you had tests done, it is your responsibility to get your test results. Ask your health care provider or the department performing the test when your results will be ready.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

The following instructions can help prevent digoxin toxicity from happening again (recurring):

• Take your digoxin medicine exactly as prescribed.
  • If you miss a dose, take it as soon as you can, unless it is almost time to take your next dose. If it is almost time for your next dose, take that one dose as normal. Do nottake two doses at the same time.
  • Take your digoxin doses at regular intervals. Do nottake your medicine more often than directed.
  • Swallow your digoxin medicine with water. It is best to take digoxin on an empty stomach, at least 1 hour before a meal or 2 hours after a meal.
• Take over-the-counter and prescription medicines only as told by your health care provider.
  • Check with your health care provider before stopping or starting any medicines.
  • Do nottake antacids without your health care provider’s permission.
  • Do nottake over-the-counter medicines for pain, allergies, coughs, or colds without your health care provider’s permission.
• Follow instructions from your health care provider about eating or drinking restrictions.
• Tell all health care providers who care for you that you are taking digoxin.
• Keep a list of all of the drugs that you take, including over-the-counter medicines, nutritional supplements, and herbal products. Bring this list with you to all of your medical visits.
• Read the drug inserts that come with your medicines.
• Check your heart rate and blood pressure regularly. Ask your health care provider what your heart rate and blood pressure should be, and when you should seek medical care.
• Have your digoxin, potassium, and magnesium levels checked regularly.

Get help right away if:

• You develop symptoms of digoxin toxicity.
• You develop chest pain.
• You have shortness of breath.
• You faint.
• You have a heartbeat that is too fast or too slow.