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(di JOKS in)

Brand Names: US

  • Digitek [DSC]
  • Digox [DSC]
  • Lanoxin
  • Lanoxin Pediatric

Therapeutic Category

  • Antiarrhythmic Agent, Miscellaneous
  • Cardiac Glycoside

Medication Safety Issues

Sound-alike/look-alike issues:

Digoxin may be confused with Desoxyn, doxepin

Lanoxin may be confused with Lasix, levothyroxine, Levoxyl, Levsinex, Lomotil, Mefoxin, naloxone, Xanax

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs which have a heightened risk of causing significant patient harm when used in error.

Older Adult: High-Risk Medication:

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). 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 2019]).

Pharmacy Quality Alliance (PQA): Digoxin (at doses greater than 0.125 mg/day) is identified as a high-risk medication in patients 65 years and older on the PQA’s Use of High-Risk Medications in the Elderly performance measure, a safety measure used by the Centers for Medicare and Medicaid Services (CMS) for Medicare plans (PQA 2017).

International issues:

Lanoxin [US, Canada, and multiple international markets] may be confused with Limoxin brand name for ambroxol [Indonesia] and amoxicillin [Mexico]

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