Mild-to-moderate heart failure (with a diuretic and an ACE inhibitor when possible). Increase myocardial contractility in pediatrics with heart failure. Control of ventricular response rate in chronic atrial fibrillation.
Digoxin is a cardiac glycoside used in the management of particularly atrial fibrillation and in heart failure.The principal actions of digoxin are an increase in the force of myocardial contraction (positive inotropic activity and a reduction in the conductivity of the heart particularly in conduction through the atrioventricular node. Digoxin also has a direct action on vascular smooth muscle and indirect effects mediated primarily by the autonomic nervous system and particularly by an increase in vagal activity.
Heart failure; Supraventricular arrhythmias: Adult: Rapid digitalisation; Loading dose of 0.75-1.5 mg during the 1st 24-hr period as a single dose or in divided doses every 6 hr for less urgent or greater risk cases. For mild heart failure; Loading dose may not be required, 250 rncg 1-2 times daily. For patients w/ normal renal function, steady-state plasma concentrations are usually achieved in about 7 days. Usual maintenance: 125-250 mcg daily but may range from 62.5-500 mcg daily. Child: Neonate <1.5kg; Initial: 25 mcg/kg/day in 3 divided doses for 24 hr, then 4-6 mcg/ kg/ day in 1-2 divided doses; neonate 1.5-2.5 kg: Initial; 30 mcg/kg/day in 3 divided doses for 24 hr, then 4-6 mcg/kg/ day in 1-2 divided doses; Neonate >2.5 kg & child 1 mth-2 yr; Initial; 45 mcg/kg/day in 3 divided doses for 24 hr, then 10 mcg/ kg/day in 1-2 divided doses. 2-5 yr; Initial; 35 mcg/kg/day in 3 divided doses for 24 hr, then 10 mcg/kg/day in 1-2 divided doses. 5-10 yr; Initial; 25 mcg/ kg/day (max: 750 mcg/day) in 3 divided doses for 24 hr, then 6 mcg/kg/day (max; 250 mcgl day) in 1-2 divided doses. 10-18 yr: Initial: 0.75-1.5mg/day in 3 divided doses for 24 hr, then 62.5-750 mcg/day in 1-2 divided doses. Reduce doses if patient has been given cardiac glycoside in the preceding 2 wk. Elderly; Lower doses are given. INTRAVENOUS Emergency heart failure: Adult: For patients who have not received cardiac glycosides in the previous 2 wk. 0.5-1 mg by IV infusion as a single dose over at least 2 hr or in divided doses ml each dose given over 10-20 minutes. Maintenance dose is usually given orally.
Potassium-depleting diuretics increase the effects of digitalis. Calcium particularly if administered rapidly by the intravenous route, may produce serious arrhythmia in digitalized patients. Quinidine, verapamil, amiodarone, propafenone, indomethacin, itraconazole, alprazolam, spironolactone, erythromycin, clarithromycin (and possibly other macrolide antibiotics) and tetracycline increase digoxin serum level. Besides antacids, kaolinpectin, sulfasalazine, neomycin, penicillamine, calestipol, metoclopramide, rifampin may interfere with intestinal absorption of digoxin resulting low serum concentrations of the drug.
Digitalis toxicity, ventricular tachycardia/fibrillation, obstructive cardiomyopathy. Arrhythmias due to accessory pathways (e.g. Wolff- Parkinson-White syndrome). Cardiac dysrhythmias, hypokalaemia, hypertension, IHD, hypercalcaemia, hypomagnesaemia, electroconversion, chronic cor pulmonale, aortic valve disease, acute myocarditis, congestive cardiomyopathies, constrictive pericarditis, heart block, elderly, renal impairment, abnormalities in thyroid function; pregnancy. IV digoxin can only be given to patients who have not received cardiac glycosides in the preceding 2 wk.
Extra beats, anorexia, nausea & vomiting. Diarrhoea in elderly, confusion, dizziness, drowsiness, restlessness, nervousness, agitation & amnesia, visual disturbances, gynaecomastia, local irritation (IM/SC mi), rapid IV admin may lead to vasocostriction & transient hypertension. Cardiac arrhythmias in combination w/ heart block.
There is no evidence of birth defects associated with digoxin use during pregnancy. Animal studies have been completed, but no human studies are available so possible risks to the human fetus are relatively unknown. Pregnant women have been treated with digoxin during pregnancy without negative effects on the fetus or reports of birth defects of any kind. However, due to the possibility of unknown side effects or birth defects, digoxin should only be used if the prescribing physician feels the benefits of treatments outweigh the possibility of fetal effects. Digoxin use is generally considered safe while breastfeeding. Only a small fraction of the drug passes to the infant in milk. However, due to the various dose levels currently used for treatment, breastfeeding women should discuss digoxin use with the prescribing physician before starting treatment or changing treatment.
Store in a cool and dry place.Keep out of the reach of children.
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