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Initial digoxin maintenance dose for adult patients with heart failure targeting a serum concentration of 0.5 to 0.9 nmol/L◊

Initial digoxin maintenance dose for adult patients with heart failure targeting a serum concentration of 0.5 to 0.9 nmol/L◊
Ideal body weight (kg)* Creatinine clearance (mL/minute) Digoxin oral dose per day (mg)
45 to 50 15 to 60 0.0625Δ
>60 0.125
51 to 60 15 to 45 0.0625Δ
46 to 110 0.125
>110 0.25
61 to 70 15 to 35 0.0625Δ
36 to 110 0.125
>110 0.25
71 to 80 ≤20 0.0625Δ
21 to 80 0.125
>80 0.25
81 to 90 15 to 70 0.125
>70 0.25
This table provides initial dose recommendations based upon a nomogram tested at a single center in nondialysis patients. Dose adjustment(s) according to clinical response and serum digoxin concentration(s) at steady state (ie, after ≥7 to 10 days of therapy) may be necessary. 

NOTE: This nomogram is not for use in patients with stage 5 chronic kidney disease and/or receiving renal replacement therapy◊. Dosing recommendations are provided separately in the clinical topic discussion. Alternative renal dose adjustment recommendations are available in the Lexicomp digoxin drug monograph included in UpToDate.

* A calculator to determine ideal body weight is available in UpToDate.
¶ A calculator to estimate creatinine clearance according to Cockcroft and Gault equation is available in UpToDate.
Δ 0.0625 mg daily dose can alternatively be given as 0.125 mg every other day.
◊ Patients with unstable renal function or stage 5 renal disease requiring renal replacement therapy, pregnant patients, and patients who were receiving medications known to significantly interact with digoxin (eg, amiodarone, quinidine, verapamil, or macrolide antibiotics) were excluded from the population in which this nomogram was validated.
Adapted from DiDomenico RJ, Bress AP, Na-Thalang K, et al. Use of a simplified nomogram to individualize digoxin dosing versus standard dosing practices in patients with heart failure. Pharmacotherapy 2014.
Graphic 90157 Version 15.0

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