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Hypocalcemia can nullify the effects of digoxin in humansthusdigoxin may be ineffective until serum calcium is restored to normalThese interactions are related to the fact that digoxin affects contractility and excitability of the heart in a manner similar to that of calcium.

Digoxin is primarily excreted by the kidneysthereforepatients with impaired renal function require smaller than usual maintenance doses of digoxinsee DOSAGE AND ADMINISTRATIONBecause of the prolonged elimination half-lifea longer period of time is required to achieve an initial or new steady-state serum concentration in patients with renal impairment than in patients with normal renal functionIf appropriate care is not taken to reduce the dose of digoxinsuch patients are at high risk for toxicityand toxic effects will last longer in such patients than in patients with normal renal function.

Newborn infants display considerable variability in their tolerance to digoxinPremature and immature infants are particularly sensitive to the effects of digoxinand the dosage of the drug must not only be reduced but must be individualized according to their degree of maturity.

Store at room temperature away from light and moistureDo not store in the bathroomKeep all medications away from children and pets.

Avoid becoming overheated or dehydrated during exercisein hot weatheror by not drinking enough fluidsDigoxin overdose can occur more easily if you are dehydrated.

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