|Therapeutic Area||Formulary Choices||Cost for 28|
(unless otherwise stated)
|Rationale for decision / comments|
|Cardiac glycosides||Digoxin||62.5mcg tablets: £1.49 (28)|
125mcg tablets: £1.56 (28)
250mcg tablets: £1.60 (28)
|Digoxin is included in the formulary for use:
• Atrial fibrillation
Consider digoxin monotherapy for initial rate control for people with non-paroxysmal atrial fibrillation if:
• the person does no or very little physical exercise or
• other rate-limiting drug options are ruled out because of comorbidities or the person's preferences. 
If monotherapy does not control the person's symptoms, and if continuing symptoms are thought to be caused by poor ventricular rate control, consider combination therapy with any 2 of the following:
• a beta-blocker
• digoxin. 
In April 2021, this was an off-label use of diltiazem. See NICE's information on prescribing medicines.
• Heart failure: where symptoms persist (due to reduced ejection fraction) despite optimum therapy including ACEIs, B-Blockers and diuretics.
U&Es should be checked at least 6-monthly, or when drug treatment is changed. Monitoring serum potassium is particularly important in patients’ taking digoxin or an aldosterone antagonist. A serum digoxin level should be measured within 8-12 hours of the latest dose only if toxicity or non-adherence is suspected.
Doses of greater than 250mcg per day in adults and greater than 125mcg in patients over 70years should rarely be seen.