Factors Enhancing Toxicity

A variety of factors increase susceptibility to digitalis toxicity. True end organ sensitivity is seen with myocardial disease or ischemia, and metabolic or electrolyte abnormalities. Hypokalemia, hypomagnesemia, and hypercalcemia all predispose to increased toxicity.3 The elderly are more susceptible to toxicity. Decreased renal function, hepatic disease, hypothyroidism, chronic obstructive pulmonary disease, and drug interactions can all augment toxic effects. 5 Drug interactions potentially resulting in digitalis toxicity include quinidine, procainamide, b blockers, calcium channel blockers, amiodarone, spironolactone, indomethacin, clarithromycin, and erythromycin.

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