A 79-year-old man with a background of COPD, atrial fibrillation, and chronic kidney disease stage 3b (eGFR 36) has been on Digoxin 250 micrograms dai...

Question

A 79-year-old man with a background of COPD, atrial fibrillation, and chronic kidney disease stage 3b (eGFR 36) has been on Digoxin 250 micrograms daily for rate control for 5 years. His heart rate is 62 bpm and his Digoxin level is 1.8 nmol/L (therapeutic range 1.0-2.0, but ideally

Accepted Answer

Reduce Digoxin dose to 125 micrograms daily or 62.5 micrograms daily, aiming for a lower therapeutic level given his age, renal impairment, and the evidence that lower levels (0.5-1.0 nmol/L) are associated with better outcomes in older people

Answer

Continue at the current dose as the level is within the quoted range

Answer

Increase Digoxin to 375 micrograms daily for better rate control

Answer

Stop Digoxin completely and switch to Verapamil

Answer

Check Digoxin level again in 6 months without dose change

uk-dgm MCQ (SBA): Digoxin Level Target in Older People with CKD