• Instruct patient to take medication as directed, at the same time each day. Teach parents or caregivers of infants and children how to accurately measure medication. Take missed doses within 12 hr of scheduled dose or omit. Do not double doses. Consult health care professional if doses for 2 or more days are missed. Do not discontinue medication without consulting health care professional.

• Teach patient to take pulse and to contact health care professional before taking medication if pulse rate is <60 or >100.

• Pedi: Teach parents or caregivers that changes in heart rate, especially bradycardia, are among the first signs of digoxin toxicity in infants and children. Instruct parents or caregivers in apical heart rate assessment and ask them to notify a health care professional if heart rate is outside of range set by health care professional before administering the next scheduled dose .

• Review signs and symptoms of digitalis toxicity with patient and family. Advise patient to notify health care professional immediately if these or symptoms of HF occur. Inform patient that these symptoms may be mistaken for those of colds or flu.

• Instruct patient to keep digoxin tablets in their original container and not to mix in pill boxes with other medications; they may look similar to and may be mistaken for other medications.

• Advise patient that sharing of this medication can be dangerous.

• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, or herbal products. Advise patient to avoid taking antacids or antidiarrheals within 2 hr of digoxin.

• Advise patient to notify health care professional of this medication regimen before treatment.

• Patients taking digoxin should carry identification describing disease process and medication regimen at all times.

• Geri: Review fall prevention strategies with older adults and their families.

• Emphasize the importance of routine follow-up exams to determine effectiveness and to monitor for toxicity.