Digoxin Drug uses, Generic/Brand Names, Category, Indications, Dosage, Mechanism of Action, Side Effects,
Precautions, Drug-Drug interactions, Drug-Food Interactions.
Image source: Digoxin Injection USP
Generic Name: Digoxin.
Brand Names: Cardin, Cardioxin, Lanoxin, Sangoxin.
Category / Class: Cardiac glycosides.
Indications: Congestive heart failure, Cardiac Tachyarrhythmia.
Image source: Digoxin Oral tablets and Solution
The main use of digoxin is to control the ventricular rate (and therefore improve cardiac output) in patients with atrial fibrillation. Digoxin is usually given orally, but if it is impossible, or if a rapid effect is required, it may be given intravenously. This is acceptable in most settings, but if clinical circulation attitudes are more urgent, therapeutic plasma concentration can be achieved more rapidly by giving a loading dose.
Atrial Fibrillation/Congestive Heart Failure uses doses:
(*OD= Once a Day*)
(* BD= Twice a day/ 2 Times a day*)
(*TD= 3 Times a day*)
Tablets: 10-15 Mcg/Kg (OD) Oral
Injectable Solution: 8-12 Mcg/kg (OD) IV
Oral Solution:10-15 Mcg/kg (OD) Oral
Tablets : 3.4-5.1 Mcg/Kg (OD)Oral
Injectable Solution: 2.4-3.6 Mcg/kg(OD)IV
Oral Solution:3.0-4.5 Mcg/Kg (OD) Oral
Children’s: (Pediatrics):- Congestive heart failure uses doses:
(*OD= Once a Day*)
Injectable solution: 15-25 Mcg/Kg (OD)IV
Oral Solution: 20-30 Mcg/Kg (OD)Oral
Injectable Solution: 20 -30 Mcg/Kg (OD)IV
Oral solution: 25 – 35 Mcg/Kg (OD) Oral
1- 2 Years:-
Injectable Solution: 30-50 Mcg/Kg (OD)IV
Oral solution: 35-60 Mcg/Kg (OD) Oral
Injectable Solution: 25-35 Mcg/Kg (OD) IV
Oral solution: 30- 45 Mcg/Kg (OD) Oral
Injectable Solution:15-30 Mcg/Kg (OD) IV
Oral solution: 20-35 Mcg/Kg (OD) Oral
Tablets: 20-45 Mcg/Kg (OD)Oral
10 – 18 Years:-
Injectable Solution: 8-12 Mcg/Kg (OD)IV
Oral solution: 10-15 Mcg/Kg (OD)Oral
Tablets: 10-15 Mcg/Kg (OD)Oral
(*TD= 3 times a Day*)
Injectable Solution: 1.9-3.1 mcg/kg (TD)IV
Oral solution:2.3-3.9 mcg/kg (TD)Oral
Injectable Solution:3-4.5 mcg/kg (TD)IV
Oral solution: 3.8-5.6 mcg/kg (TD)Oral
Injectable Solution:4.5-7.5 mcg/ kg (TD)IV
Oral solution: 5.6-9.4 mcg/kg (TD)Oral
Injectable Solution: 3.8-5.3 mcg/kg (TD)IV
Oral solution: 4.7-6.6 mcg/kg (TD)Oral
Injectable Solution: 2.3-4.5 mcg/kg (TD)IV
Oral solution: 2.8-5.6 mcg/kg (TD)Oral
Tablets: 3.2-6.4 mcg/kg (TD)Oral
Injectable Solution: 2.4-3.6 mcg/kg (OD)IV
Oral solution: 3-4.5 mcg/kg (OD)Oral
Tab lets: 3.4-5.1 mcg/kg (OD)Oral
Route of Administration:-
May be taken with or without food- Oral, IV
Once a day (OD), twice a day / 2 Times a day (BD), 3 Times a day (TD)
Hypokalemia, ventricular tachycardia, Partial atrioventricular block, Acute myocarditis, Wolf -Parkinson – White Syndrome.
Elderly, Renal or severe hepatic disease, myocardial infarction, thyrotoxicosis, calcium synergises to precipitate toxicity.
Pediatrics: Reduce dose necessary.
Pregnancy category: C : No evidence of risk.
Lactation: Present in breast milk hence use only if indicated.
Adverse Drug Reaction’s (ADR’s):-
Tachycardia, Cardiac arrhythmia, heart block.
Anorexia, nausea, vomiting, abdominal pain, fatigue, headache, mental confusion, restlessness, Weakness, Rash, Dizziness.
Mechanism Of Action:-
The mechanism of action inhibits digoxin Sodium / Potassium + adenosine Triphosphates (Na/ K + ATPase). It increases intracellular concentrations by intracellular Sodium accumulation and reduced sodium exchange. The increase in intracellular Calcium + availability is attributed to the positive isotropic effect of digoxin. Excessive inhibition of sodium / potassium ATPase causes many non-cardiac (dysrhythmogenic) toxic effects.
Ventricular slowing due to increased vagal activity in the AV node. Improving ventricular filling during diastole improves cardiac output in patients with atrial fibrillation. Clinical progression is measured by measuring the heart rate (at the peak): epicardial rates can be achieved at 70 – 80 per minute during rest.
Unfortunately, because vagal activity is suppressed during exercise (when the heart rate is controlled by sympathetic activity), rate control is not usually achieved when exercising.
Digoxin Major Drug Interactions:-
These combinations of medicines may lead to higher blood levels of digoxin. Digoxin levels ought to be firmly checked on the off chance that you begin on Amiodarone.. If you have symptoms of high digoxin levels such as nausea, decrease of appetite, visual disturbances, slow pulse, or irregular heartbeats. It is necessary to inform your doctor regarding all different medications you utilize
Digoxin + Adenosine:-
Combinations of these medications can increase the risk of an irregular Heart Rhythm that may be serious. You may would like a dose adjustment or a lot of frequent watching by your doctor to securely use each medications.
Digoxin + Calcium Chloride:-
These combinations of medicines together can affect the rhythm of your heart. Consult your doctor if you have uneven heartbeat, blurred vision, chest tightness, seizures and nausea. You may need a dose adjustment or need your blood levels checked more often if you take both medications. It is vitalto inform your doctor concerning all alternative medications you use.
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