Canadian Pharmacist Qualifying Exam Practice · Question
A 45-year-old female weighing 70 kg is prescribed digoxin 0.25 mg daily for atrial fibrillation. Her serum creatinine is 120 micromol/L (normal 50-100 micromol/L) and her calculated creatinine clearance is 45 mL/min. Given that digoxin is primarily renally excreted and has a narrow therapeutic index, what adjustment, if any, should the pharmacist recommend?
Digoxin is primarily eliminated by the kidneys. In patients with impaired renal function (CrCl <50 mL/min), the dose and/or frequency of digoxin should be reduc
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Question: A 45-year-old female weighing 70 kg is prescribed digoxin 0.25 mg daily for atrial fibrillation. Her serum creatinine is 120 micromol/L (normal 50-100 micromol/L) and her calculated creatinine clearance is 45 mL/min. Given that digoxin is primarily renally excreted and has a narrow therapeutic index, what adjustment, if any, should the pharmacist recommend?
Answer options:
- Increase the dose to 0.5 mg daily.
- Maintain the current dose of 0.25 mg daily. ✅ Decrease the dose to 0.125 mg daily or every other day.
- Switch to a different antiarrhythmic medication.
Correct answer: Decrease the dose to 0.125 mg daily or every other day.
Explanation: Digoxin is primarily eliminated by the kidneys. In patients with impaired renal function (CrCl <50 mL/min), the dose and/or frequency of digoxin should be reduced to prevent accumulation and toxicity. Reducing the dose to 0.125 mg daily or every other day is appropriate.
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