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Increased serum digoxin or phenytoin levels have been reported to occur in patients receiving desyrel trazodone hydrochloride concurrently with either of those two drugs.

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on the other hand, randomization to digoxin had no apparent effect on mortality rr 99 , with confidence limits of 91 to 107 .

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however, when treating hf with psf, extra caution is required with ace-i, vasodilators and diuretics to prevent symptomatic hypotension or pre-renal failure as lv filling pressures are volume dependent it is important to treat the following underlying cause where possible, especially in the case of hf with psf hypertension goal is blood pressure 30 evaluate the patient s volume status and consider reducing holding diuretic if volume deplete before reducing holding digoxin, ace-i, arb, spironolactone or bb referral to a nephrologist is encouraged when there is kidney impairment as defined by a cr increase by 30 , an egfr 30 ml min should receive standard therapy with an ace-i, arb or spironolactone use digoxin with extreme caution monitor serum potassium k and cr levels more frequently, especially with combination therapy or in the case of an acute intercurrent illness hf patients with persistent volume overload or deteriorating renal function should be assessed for reversible causes – medications especially nsaids , hypovolemia, hypotension, urinary tract obstruction or infection stable oliguric hf patients – daily evaluation of the dose of diuretics, ace-i, arb, spironolactone and non-hf drugs that impair renal function is recommended preferably as an inpatient stable non-oliguric hf and cr increase 30 from baseline – consider reducing the dose of diuretics, ace-i, arb and spironolactone until renal function stabilizes referral to a nephrologist is encouraged when there is kidney impairment as defined by a cr increase of 30 , an egfr 75 years female gender ventricular arrhythmias non-sustained ventricular tachycardia and atrial fibrillation nyha hf classes 3 and 4 lvef 70 mm high bnp levels see table 1 – use of bnp for prognostication requires further study low-serum sodium 120 ms implantable defibrillator possibly indicated with lvef caregivers should be consulted to determine their degree of burden it is important to ensure that advance care planning has been carried out, including financial and health care decisions e.


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