Digoxin toxicity is increased by all except
PRECAUTIONS AND CONTRAINDICATIONS (a) Hypokalemia, hypomagnesemia, hypercalcaemia: enhances digitalis toxicity. (b) Elderly, renal or severe hepatic disease: patients are more susceptible to digoxin toxicity. (c) Myocardial ischaemia: severe arrhythmias are more likely. (d) Thyrotoxicosis: patients are more prone to develop digitalis arrhythmias. (e) Myxoedema: these patients eliminate digoxin more slowly; cumulative toxicity can occur. (f) Ventricular tachycardia: digitalis is contraindicated because it may precipitate ventricular fibrillation. (g) Paial A-V block: may be conveed to complete A-V block by digoxin. (h) Acute myocarditis: Diphtheria, acute rheumatic carditis, toxic carditis--inotropic response to digitalis is poor, more prone to arrhythmias. (i) Wolff-Parkinson-White syndrome: Digitalis is contraindicated because it decreases the ERP of bypass tract in 1/3 patients. In them rapid atrial impulses may be transmitted to ventricles - VF may occur. Digitalis can increase the chances of reentry by slowing conduction in the normal A-V bundle and accelerating it in the aberrant pathway. Ref:- kd tripathi; pg num:-516,517
Hyperkalemia
Hypercalcemia
Hypomagnesemia
Renal impairment
Cardiovascular system