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. [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.