What is a primary concern when prescribing digoxin?

A primary concern when prescribing digoxin is toxicity, particularly in patients with renal impairment. Digoxin has a narrow therapeutic index, meaning the difference between a therapeutic dose and a toxic dose is small, which makes monitoring very important.

In patients with renal impairment, the clearance of digoxin is reduced, leading to an increased risk for accumulation in the body and potential toxicity. Symptoms of digoxin toxicity can include nausea, vomiting, dizziness, visual disturbances, and cardiac arrhythmias. Therefore, it is essential to assess renal function prior to prescribing digoxin and to monitor digoxin levels and renal function regularly during treatment to mitigate this risk.

While drug interactions, increased heart rate, and patient demographics like age and weight are important considerations when prescribing medications, they are secondary to the critical concern of digoxin toxicity in the context of renal function.