Why has the IV digoxin rate changed from 10-20 minutes to an infusion over 2 hours?
On the whole, the BNF reflects licensed doses. However, sometimes, because of safety, efficacy or for practical considerations, the BNF does provide alternative advice. On these occasions the advice is carefully verified by expert clinicians and it is vetted by the Joint Formulary Committee. The dose of intravenous digoxin is an example of this. Advice to infuse digoxin 0.75-1 mg over at least 2 hours has been in the BNF for many years. However, in editions prior to BNF 42, this advice was in the preamble to section 2.1.1. The digoxin entry reflected the licensed dose and it included a cross-reference to the notes for an alternative regimen. This was confusing. Therefore, for BNF 42, the licensed dose was dropped after, once again, confirming the appropriateness of the alternative dose with expert advisers and with the Joint Formulary Committee. BNF 43 was amended further to warn that even after intravenous administration, response may take a number of hours and persistence of tachycar
