Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
Cardiac glycosidesDigoxin62.5mcg 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. [2021]

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
• diltiazem
• digoxin. [2021]
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.