In a patient with worsening dyspnea and abdominal discomfort, which medication should be held if the serum digoxin concentration is above 1 ng/mL?

In this scenario, holding digoxin is the appropriate course of action when serum digoxin concentrations exceed 1 ng/mL. Elevated levels of digoxin can lead to an increased risk of toxicity, which is particularly concerning if a patient is exhibiting worsening symptoms such as dyspnea and abdominal discomfort. Digoxin is a cardiac glycoside that can have various effects on the heart, and maintaining safe serum levels is crucial to avoid complications such as arrhythmias, gastrointestinal symptoms, and neurologic effects.

When digoxin levels are elevated, the mechanism of action may inadvertently lead to more severe side effects rather than therapeutic benefits. Monitoring serum concentrations, especially in patients with signs of toxicity or worsening clinical conditions, is critical in managing the treatment plan. Other medications listed, such as sacubitril/valsartan, spironolactone, and carvedilol, do not require holding solely based on elevated digoxin levels, thus supporting the decision to manage digoxin carefully in this patient scenario.