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Aim: Digoxin is considered contraindicated in light-chain (AL) amyloidosis, given reports of increased toxicity published 30–50 years ago. We sought to determine the frequency of digoxin toxicity in patients with AL.

Methods: We identified 107 patients with AL amyloidosis who received digoxin between 2000 and 2015.

Results: The median age was 65 and the median digoxin dose and estimated glomerular filtration rate were 0.125 mg/d and 55 ml/min/1.73 m², respectively. Digoxin dose was reduced in 16% of the patients, mainly due to high serum drug concentration or worsening renal function. The median duration of therapy was 5 months, with half of the patients stopping treatment, primarily due to physician preference. Significant arrhythmias developed in 11% of patients, almost exclusively in newly diagnosed patients. Arrhythmias presented as terminal events in five patients; four with bradycardia followed …