netFormulary Leicestershire Health Community NHS
Medicines Formulary  
 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.01.01  Expand sub section  Cardiac glycosides
  • Digoxin controls the ventricular rate in patients with persistent or permanent atrial fibrillation, especially when it occurs with heart failure. It is also used in the treatment of supraventricular tachycardias and atrial flutter but not ventricular arrhythmias.
  • Digoxin should only be considered as monotherapy for permanent AF in predominantly sedentary patients who need treatment for rate control.
  • A loading dose may be given on initiation of therapy to achieve a rapid therapeutic effect; otherwise it will take about a week to obtain maximal effect. An oral loading dose is often satisfactory but for a more rapid onset it can be given by intravenous infusion. Even with intravenous administration, response may take many hours; persistence of tachycardia is therefore not an indication for exceeding the recommended dose.
  • In patients with heart failure who are in sinus rhythm a loading dose is not required, and a satisfactory plasma-digoxin concentration can be achieved over a period of about a week.
  • Intramuscular injection should be avoided as it is painful and absorption is variable.
  • Age and renal function are key determinants of the dosing regimen.
View adult BNF View SPC online  Track Changes
First Choice
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Track Changes
Display tracking information
click to search
Link to adult BNF
click to search
Link to children's BNF
click to search
Link to SPCs
Scottish Medicines Consortium
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHS England

Traffic Light Status Information

Status Description


Drugs not recommended for use in the Leicestershire Health Community because of lack of evidence of clinical effectiveness, cost prioritization or concerns over safety. All new drugs will be black until they have been through the appropriate approval process - then they will appear as a specific entry   


Drugs which should be prescribed only by hospital specialists (clinical review by specialist as appropriate and annually as a minimum).  

Amber SCA

Drugs which would initially be prescribed by a hospital specialist and then by a GP where full agreement to share the care of each specific patient has been reached under a LMSG Shared Care Agreement (SCA). Specific patient monitoring or intervention required.   

Amber Simple

Drugs suitable to be initiated and prescribed in primary care only after specialist assessment and recommendation. A shared care agreement is not required.  

Green Conditional

Drugs for which GPs are able to take full responsibility for prescribing and monitoring subject to specified conditions e.g. prescribing in line with agreed LMSG guidance or able to demonstrate suitable competence see comments under individual entries.   


Drugs for which GPs would normally take full responsibility for prescribing and monitoring. Drugs included in this list have been specifically considered by LMSG.