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Brand names: Lanoxin • Drug class: Cardiac glycoside
Digoxin is a heart-failure and atrial-fibrillation drug with a narrow therapeutic window — and it is eliminated largely by the kidneys. CKD patients need smaller doses and careful monitoring, because toxicity (nausea, visual changes, arrhythmias) develops at lower doses when clearance falls.
Digoxin is ~60-75% renally cleared. In CKD, the half-life extends markedly and levels climb — toxicity risk is high. Standard practice: reduce dose for reduced GFR (often every-other-day dosing at low GFR), and monitor digoxin levels (target typically 0.5-0.9 ng/mL in heart failure). Interactions matter: amiodarone, verapamil, and many others raise digoxin levels.
Renal clearance of digoxin ~60-75%; dose reduction required as GFR falls
Pharmacokinetic literature, 2023
Lower target levels (0.5-0.9 ng/mL) preferred in heart failure
Guideline consensus, 2022
CrCl >50: standard doses. CrCl 20-50: ~50-75% of standard. CrCl <20/dialysis: ~25-50%, often every-other-day. Check digoxin level 1-2 weeks after any change. Hold for symptoms of toxicity.
Check your kidney functionThis page is educational. Medication decisions — especially dosing changes — must be made by your prescribing clinician.
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