Medication Safety Issues
Digoxin may be confused with Desoxyn, doxepin
Lanoxin may be confused with Lasix, levothyroxine, Levoxyl, Levsinex, Lomotil, Mefoxin, naloxone, Xanax
The Institute for Safe Medication Practices (ISMP) includes this medication (IV and oral formulations) and also drug class (antiarrhythmics, IV; inotropic medications, IV) among its list of drugs/classes which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Acute Care and Long-Term Care Settings).
Beers Criteria: Digoxin is identified in the Beers Criteria as a potentially inappropriate medication to be avoided in patients 65 years and older as first-line therapy for atrial fibrillation (due to safer and more effective alternatives for rate control) or as first-line therapy for heart failure (due to conflicting and low quality evidence for benefits and harms, evidence that other agents decrease hospitalizations and mortality, and lack of additional benefit when higher doses are used despite the increased risk of toxicity). Exercise caution when discontinuing therapy in patients with heart failure with reduced ejection fraction due to limited evidence suggesting worse outcomes following discontinuation. If used, avoid doses greater than 0.125 mg/day due to decreased renal clearance of digoxin which may result in increased risk of toxic effects; further dose reductions may be warranted in patients with Stage 4 or 5 chronic kidney disease (Beers Criteria [AGS 2023]).
Digoxin is identified in the Screening Tool of Older Person's Prescriptions (STOPP) criteria as a potentially inappropriate medication in older adults (≥65 years of age) as first-line therapy for long-term (>3 months) treatment in atrial fibrillation. In addition, some disease states of concern include renal impairment, heart failure, bradycardia, heart block, or history of QTc prolongation (O’Mahony 2023).
Lanoxin [US, Canada, and multiple international markets] may be confused with Limoxin brand name for ambroxol [Indonesia] and amoxicillin [Mexico]
