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Take the missed dose as soon as you rememberSkip the missed dose if your next dose is less than 12 hours awayDo not take extra medicine to make up the missed dose.

It may be desirable to reduce the dose of or discontinue digoxin for 1 to 2 days prior to electrical cardioversion of atrial fibrillation to avoid the induction of ventricular arrhythmiasbut physicians must consider the consequences of increasing the ventricular response if digoxin is decreased or withdrawnIf digitalis toxicity is suspectedelective cardioversion should be delayedIf it is not prudent to delay cardioversionthe lowest possible energy level should be selected to avoid provoking ventricular arrhythmias.

LANOXIN may cause severe sinus bradycardia or sinoatrial block particularly in patients with pre-existing sinus node disease and may cause advanced or complete heart block in patients with pre-existing incomplete AV blockConsider insertion of a pacemaker before treatment with digoxin.

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