Epidemiology

Digoxin usage is decreasing due to its inferiority to other heart failure medications and digoxin toxicity has, therefore, become less common; but it is at risk of being overlooked.[2]

Using 2005–2010 reports from the National Electronic Injury Surveillance System, an estimated 5156 emergency department visits for digoxin toxicity occurred annually in the US, of which >75% resulted in hospital admissions.[3] Digoxin toxicity accounted for approximately 1.0% of all emergency department visits for all adverse drug events among patients aged ≥40 years; this figure was estimated to be 3.3% for patients aged ≥85 years.[3]

In 2022, the American Association of Poison Control Centers reported 266 fatalities following exposure to cardiovascular drugs; digoxin was the first ranked pharmaceutical in 21 of these deaths.[4] Patients aged >55 years are more commonly affected, but toxicity occurs in both young and old people.[5][6]​ Drug-drug interactions involving digoxin are a common cause of adverse drug effects in older people.[7] Rate of emergency department visits and hospitalization for digoxin toxicity appear to be greater for women than men.[3][8]

Young children are mainly at risk of unintentional medication overdose; adults are mainly at risk from intentional ingestions in a suicide attempt. Dosing errors, increased bioavailability, and decreased clearance may also result in overdose.

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