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The majority of clinical experience gained with digoxin has been in the elderly populationThis experience has not identified differences in response or adverse effects between the elderly and younger patientsHoweverthis drug is known to be substantially excreted by the kidneyand the risk of toxic reactions to this drug may be greater in patients with impaired renal functionBecause elderly patients are more likely to have decreased renal functioncare should be taken in dose selectionwhich should be based on renal functionand it may be useful to monitor renal functionsee DOSAGE AND ADMINISTRATION

Other medications can affect the removal of digoxin from your bodywhich may affect how digoxin worksExamples include azole antifungalssuch as itraconazoledronedaronelapatinibmacrolide antibioticssuch as clarithromycinerythromycinpropafenonerifampinStJohn’s wortamong others.

Digoxin has a narrow therapeutic indexincreased monitoring of serum digoxin concentrations and for potential signs and symptoms of clinical toxicity is necessary when initiatingadjustingor discontinuing drugs that may interact with digoxinPrescribers should consult the prescribing information of any drug which is co-prescribed with digoxin for potential drug interaction information.

Among the extra-cardiac manifestationsgastrointestinal symptomse.gnauseavomitinganorexiaare very commonup to 80incidenceand precede cardiac manifestations in approximately half of the patients in most literature reportsNeurologic manifestationse.gdizzinessvarious CNS disturbancesfatigueand malaise are very commonVisual manifestations may also occur with aberration in color visionpredominance of yellow greenthe most frequentNeurological and visual symptoms may persist after other signs of toxicity have resolvedIn chronic toxicitynon-specific extra-cardiac symptomssuch as malaise and weaknessmay predominate.

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