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1. Proper timing of serum sampling is critical.
Serum samples should be drawn just prior to the daily dose and no sooner than six hours after administration of the drug.
2. Factors affecting digoxin pharmacokinetics
Hypokalemia, hypomagnesemia, coronary artery disease, cor pulmonale, uncorrected hypothyroidism, renal dysfunction, and interacting drugs which decrease digoxin clearance (quinidine, spironolactone, and verapamil).
Hyperkalemia, uncorrected hyperthyroidism, interacting drugs which delay or prevent oral absorption (antacids, cholestyramine, metoclopramide).