Full Answer
Is digoxin toxic to the kidneys?
Digoxin (Includes digoxin) ↔ renal dysfunction. Patients with renal impairment may be at increased risk for digoxin toxicity, including ventricular arrhythmias and AV conduction disturbances, due to decreased drug clearance. Therapy with digoxin should be administered cautiously in patients with impaired renal function.
Is digoxin contraindicated in patients with ventricular fibrillation?
View all 13 references. The use of digoxin is contraindicated in patients with ventricular fibrillation. Digoxin toxicity is associated with adverse cardiac effects, including ventricular arrhythmias, which are most commonly seen in chronic toxicity.
How should digoxin be administered in patients with impaired renal function?
Therapy with digoxin should be administered cautiously in patients with impaired renal function. Dosage adjustments should be made according to product package labeling and patient attributes such as age, ideal body weight, and other concomitant disease states and medication usage.
How much digoxin is safe to take for heart failure?
The doses of digoxin tablets used in controlled trials in patients with heart failure have ranged from 125 to 500 mcg once daily. In these studies, the digoxin dose has been generally titrated according to the patient's age, lean body weight, and renal function.
Is digoxin safe in renal failure?
The effect of worsening renal function on digoxin toxicity is well known [19]. In end-stage renal disease, the fluctuating concentration of potassium during dialysis may increase the risk of digoxin toxicity. In patients with end stage renal failure, mortality increases with increasing serum digoxin levels [20].
Does digoxin affect the kidneys?
Conclusions. In this subset of the DIG trial, digoxin was associated with long term improvement in kidney function, and in patients demonstrating this favorable renal response, reduction in death or hospitalization.
Does digoxin toxicity cause renal failure?
Renal failure is the most common precipitating event to digoxin toxicity causing decreased drug clearance, and is associated with worse outcomes when concurrent hyperkalemia and ventricular arrhythmias are present, as in our patient [13,14].
Which drugs are contraindicated in renal failure?
Problematic drugs whose use in patients with renal insufficiency is nephrologically contraindicated: Pethidine, cefepime, lithium, gilbenclamide, gimepiride, metformin, spironolactone, eplerenone, methotrexate, gadolinium, enoxaparin.
When should digoxin not be given?
Digoxin is not suitable for some people with certain types of arrhythmia (such as ventricular fibrillation or WPW syndrome and pre-excited atrial fibrillation) and with some other types of cardiac disease, such as myocarditis or substantial sinus or AV block unless a pacemaker is present.
What are the contraindications of digoxin?
ContraindicationsAcute myocardial infarction.Hypersensitivity to the drug.Ventricular fibrillation.Myocarditis.Hypomagnesemia.Hypokalemia.Wolf-Parkinson-White syndrome.
Is digoxin renally cleared?
Digoxin pharmacokinetics Digoxin is predominantly cleared unchanged by the kidneys, although small amounts are also cleared by other routes. In patients with normal renal function, the elimination half- life is around 36 hours.
Can dialysis patients take digoxin?
In conclusion, digoxin use among patients who are on hemodialysis associates with increased mortality, especially among those with low predialysis K concentrations. Digoxin has been used for decades for the treatment of cardiovascular disease (CVD).
How does digoxin affect creatinine?
The effect of digoxin was similar among patients in the lower three categories of serum creatinine levels but seemed beneficial in the small subgroup with the highest creatinine levels (2.0 mg/dl), contrary to our prespecified hypothesis (Table 3).
What drugs are toxic to kidneys?
What Meds Might Hurt My Kidneys?Antibiotics.Diuretics.Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)Proton Pump Inhibitors (PPIs)Supplements.Laxatives.If You Have Kidney Disease, Other Medications Can Be Harmful.
Which drug is commonly used in renal dysfunction?
Drugs used to treat Renal FailureDrug nameRatingRx/OTCGeneric name: furosemide systemic Drug class: loop diuretics For consumers: dosage, interactions, side effects For professionals: Prescribing InformationExpand current row for information about Demadex DemadexRateRx22 more rows
What drugs should be stopped in AKI?
Clinicians managing patients with AKI therefore frequently stop drugs that lower blood pressure (particularly ACEI and ARBs, which selectively reduce glomerular pressure) and diuretics. ACEIs, ARBs and potassium-sparing diuretics may also be stopped because of hyperkalaemia.
Is digoxin cleared by kidneys?
Digoxin pharmacokinetics Digoxin is predominantly cleared unchanged by the kidneys, although small amounts are also cleared by other routes. In patients with normal renal function, the elimination half- life is around 36 hours.
How does digoxin affect urine output?
No significant changes in serum digoxin were found in this active study. These results are consistent with the hypothesis that increasing glomerular filtration rate or total urine volume increases the renal excretion of digoxin and may result in increased total urinary output of this glycoside.
What are the side effects of digoxin?
Common side effectsFeeling confused, dizzy or generally unwell. ... Feeling or being sick (nausea or vomiting) and loss of appetite. ... Diarrhoea. ... Changes in your vision (including blurred vision and not being able to look at bright light) ... Skin rashes.
How does digoxin affect potassium levels?
Pathophysiology – Digoxin Toxicity Digoxin toxicity causes hyperkalemia, or high potassium. The sodium/potassium ATPase pump normally causes sodium to leave cells and potassium to enter cells. Blocking this mechanism results in higher serum potassium levels.
How is digoxin eliminated?
Digoxin is primarily eliminated by the kidney. Patients with renal impairment may be at increased risk for digoxin toxicity, including ventricular arrhythmias and AV conduction disturbances, due to decreased drug clearance. Therapy with digoxin should be administered cautiously in patients with impaired renal function. Dosage adjustments should be made according to product package labeling and patient attributes such as age, ideal body weight, and other concomitant disease states and medication usage. Dosage increments should be made very gradually, since the elimination half-life may be prolonged in these patients and a longer period of time is required to establish steady-state serum concentrations than normal. These patients should be monitored closely for manifestations of toxicity, and dosages further adjusted as necessary. If toxicity occurs, clinicians should be aware that the adverse effects may also be prolonged.
Is digoxin refractory to hyperthyroidism?
Heart failure and/or atrial arrhythmias resulting from hypermetabolic or hyperdynamic states such as hyperthyroidism , hypoxia, or arteriovenous shunt are best managed by treating the underlying condition. Atrial arrhythmias associated with hypermetabolic states are particularly refractory to digoxin, possibly due to altered pharmacokinetics. Specifically, the apparent volume of distribution and renal elimination of the drug may be increased, resulting in lower serum concentrations. Therapy with digoxin should be administered cautiously in patients with hyperthyroidism. Serum digoxin levels should be monitored regularly and dosage adjustments may be required secondary to changes in their thyroid condition.
Is digoxin contraindicated for ventricular fibrillation?
The use of digoxin is contraindicated in patients with ventricular fibrillation. Digoxin toxicity is associated with adverse cardiac effects, including ventricular arrhythmias, which are most commonly seen in chronic toxicity. Digoxin-induced ventricular tachycardia is associated with a high mortality rate, since ventricular fibrillation or asystole may result. Therapy with digoxin should be administered cautiously in patients with frequent ventricular premature contractions or ventricular tachycardia, especially if these arrhythmias are not caused by heart failure.
Can digoxin be used for impaired renal function?
Therapy with digoxin should be administered cautiously in patients with impaired renal function. Dosage adjustments should be made according to product package labeling and patient attributes such as age, ideal body weight, and other concomitant disease states and medication usage.
Can digoxin cause a decrease in cardiac output?
Patients with heart failure associated with preserved left ventricular systolic function, such as in restrictive cardiomyopathy, constrictive pericarditis, amyloid heart disease and acute cor pulmonale, may be particularly susceptible to experience decrease cardiac output. Therapy with digoxin should be administered cautiously in such patients. Patients with idiopathic hypertrophic subaortic stenosis may have worsening of the outflow obstruction due to the inotropic effects of digoxin.
Does digoxin cause atrial fibrillation?
Patients with Wolf-Parkinson-White syndrome that presents atrial fibrillation are at higher risk for ventricular fibrillation . Treatment with digoxin should be used with caution in these patients. References.
Does digoxin prolong PR?
Digoxin slows sinoatrial and AV conduction, prolonging the PR interval. When treated with digoxin, patients with preexisting sinus node disease may develop severe sinus bradycardia or sinoatrial block, and patients with incomplete AV block may progress to advanced or complete heart block. In such patients, consideration should be given to ...
How often does digoxin cause cardiac arrhythmias?
Digoxin toxicity is clinically relevant as it can lead to fatal cardiac arrhythmias. The estimated frequency is at about 0.8 to 4% of patients on steady digoxin therapy. The rate of toxicity increases as serum digoxin concentration reaches over 2.0 ng/ml. However, toxicity can also occur at lower levels, especially in the setting of other risk factors such as low body weight, advanced age, decreased renal function, and hypokalemia.
What is digoxin used for?
Digoxin is a medication used to manage and treat heart failure and certain arrhythmias, and abortion. It is in the cardiac glycoside class of drugs. This article outlines the indications, action, and contraindications for digoxin as a valuable agent in managing heart failure and certain arrhythmias. This activity will highlight the mechanism of action, toxicity profile, and other vital factors, e.g., dosing, pharmacodynamics, pharmacokinetics, and monitoring, pertinent for members of the healthcare team in the management of patients who have been prescribed digoxin.
What is the chemical formula for digoxin?
It is a cardiotonic glycoside and belongs to the digitalis class. The chemical formula of digoxin is C41 H64 O14. Cardiac glycosides, including digitalis and digoxin, have long-standing use in clinical practice. This drug received approval from the FDA in 1954 and is used to treat various heart problems such as atrial flutter, atrial fibrillation, heart failure with its associated symptoms and to induce fetal demise prior to an abortion. Superior therapies with milder adverse effects and better safety profiles have replaced it, such as beta-blockers and calcium-channel blockers. In current practice, it is reserved as a backup drug when first-line agents are ineffective. Its optimal use is in the treatment of mild to moderate heart failure in adult patients and to increase myocardial contraction.
How long should digoxin be monitored?
Clinical staff should monitor the plasma digoxin level at least 6 hours or 12 hours post-administration of the last loading dose as this is the time to achieve steady-state levels. Recommended thresholds of therapeutic serum digoxin levels are between 0.5 to 2 ng/dl.
How long does digoxin stay in the body?
Digoxin has a half-life that varies from 36 to 48 hours, which may increase in cases of renal failure. [3]
How many mechanisms of action does digoxin have?
Digoxin has two principal mechanisms of action which are selectively employed depending on the indication:
Which antifungal inhibits the transport of digoxin via human P-glycoprotein?
Azole antifungals, which inhibit the transport of digoxin via human P-glycoprotein
How does digoxin work?
We have already established that digoxin works by altering the sodium-potassium pump. These are electrolytes whose concentrations and locations are changed by digoxin. If you have an electrolyte imbalance, then digoxin is not for you. It can cause a more severe electrolyte imbalance that can lead to muscle contraction failure, kidney failure, and cardiac arrest.
What happens if digoxin is not working?
The other problem is that digoxin is cleared from the bloodstream by the kidneys, so if they aren't working well, then the drug will build-up in the bloodstream and cause a toxicity reaction which can be life-threatening.
What is digoxin used for?
Cardiac arrhythmias are any abnormal beating of the heart. Digoxin is indicated to treat: Atrial fibrillation - a condition of the heart when the upper chambers quiver or partially contract. Heart failure - heart doesn't function well enough to meet the demands of the body. Contradictions for digoxin include:
What is the best medicine for heart arrhythmias?
Digoxin treats cardiac arrhythmias. One such drug that is able to help the heart function the way that it is supposed to is digoxin. This is what is known as an antiarrhythmic drug that works by altering the sodium-potassium pump in the heart thereby affecting contractions of the heart. Lesson. Quiz.
What is the function of digoxin in the heart?
Digoxin also has the ability to affect the amount of fluids in the body and so it is very useful in treating heart failure, which is when the heart doesn't function well enough to meet the demands of the body.
What happens if you have a kidney problem?
It can cause a more severe electrolyte imbalance that can lead to muscle contraction failure, kidney failure, and cardiac arrest. The kidneys are responsible for regulating the electrolytes in your bloodstream, as well as fluid levels in the body.
What degree does Adrianne have?
Adrianne has a master's degree in cancer biology and has taught high school and college biology. This lesson is going to look at what digoxin is and what it is useful for treating. We will look at the drug and health contraindications that affect the ability to receive digoxin treatment. Create an account.
What is the role of autophagy in ageing?
Dysregulation of autophagy is associated with ageing and a variety of pathological conditions, such as neurodegeneration, cardiomyopathy, and cancer.8 Dysregulation of autophagy may be a mechanism which is implicated in the pathogenesis of renal disease, and thus targeting the pathway may be a mechanism for inducing renal protection [ 9 ]. In vitro and in vivo studies of renal tissue demonstrate autophagy during hypoxic and ischaemic renal injury [ 10 ]. Impaired renal function is commonly associated with chronic heart failure [ 11 ]. Stimulating autophagy by digoxin may have renoprotective benefits.
How to calculate eGFR?
The eGFR derived from serum creatinine was calculated using the following equation recommended by National Institute for Health and Care Excellence (NICE) and validated by the local biochemistry laboratory: eGFR ml/min/1.73 m 2 = 141 × min (S cr < /κ, 1) α × max (S cr /κ, 1) -1.209 × 0.993 Age × 1.018 [if female] × 1.159 [if black] (where Scr = serum creatinine in μmol/L, κ is 61.9 for females and 79.6 for males, α is − 0.329 for females and − 0.411 for males, min indicates the minimum of S cr /κ or 1, and max indicates the maximum of S cr /κ or 1) [ 12 ].
Does digoxin cause atrial fibrillation?
The association between worse renal function and digoxin use may be related to atrial fibrillation. We found a very strong association between atrial fibrillation and digoxin usage. The development of AF is associated with a two fold increase in risk of developing end stage renal disease in patients with chronic kidney disease (CKD), independent of baseline eGFR [ 39 ]. Animal data show that AF can cause renal vasoconstriction and decreased renal blood flow and even renal fibrosis or possibly renal micro-infarcts [ 40, 41 ]. In 386 patients with AF treated by ablation, patients who were arrhythmia free during the first year had an increase in eGFR whilst those who had recurrence of their arrhythmia had a reduction in eGFR (3 ± 8 ml/min/1.73m 2 vs − 2 ± 8 ml/min/1.73m 2, respectively: P < 0.0001) [ 42, 43 ].
What are the co-morbidities that affect renal function?
Patients may have other co-morbidities such as diabetes and hypertension which may contribute to impaired renal function. We did not categorise patients into types of renal disease.
What version of SPSS is used for statistical analysis?
Statistical analyses were performed with SPSS (version 22) and STATA (version 14.1, Stata-Corp) statistical software. All tests are two-sided, with a p -value of< 0.05 considered significant.
Does digoxin increase contractile force?
Digoxin inhibits sodium potassium adenosine triphosphatase (Na + /K + -ATPase) and in the myocardium it increases the intracellular level of sodium and calcium ions in the myocytes thus increasing cardiac contractile force [ 4 ]. This mechanism of action of digoxin has also been shown to be an autophagy stimulator [ 5 ]. Autophagy, which means ‘self-eating’ in Greek, is an intracellular degradation process for pathogens and damaged organelles by lysosomes [ 6, 7 ]. Autophagy maintains cellular homeostasis and energy production, to allow cells to function normally, and is a protective mechanism induced in response to multiple stressors [ 7, 8 ]. In the kidneys, autophagy plays an important role in the homeostasis and viability of critical renal cells such as podocytes and tubular epithelial cells [ 9 ].
What is categorical data?
Categorical data are presented as number (percentage); normally distributed continuous data as mean (standard deviation), non-normally distributed continuous variables as median (interquartile range). One-way ANOVA was used to compare means of more than two groups for continuous variables and chi-square tests were used for categorical variables.
What is Digoxin?
Digoxin has active ingredients of digo xin. It is often used in atrial fibrillation/flutter. eHealthMe is studying from 85,135 Digoxin users for its effectiveness, alternative drugs and more.
What is Acute kidney failure?
Acute kidney failure is found to be associated with 3,411 drugs and 3,243 conditions by eHealthMe.
How the study uses the data?
The study uses data from the FDA. It is based on digoxin (the active ingredients of Digoxin) and Digoxin (the brand name). Other drugs that have the same active ingredients (e.g. generic drugs) are not considered. Dosage of drugs is not considered in the study.
What is phase IV of Digoxin?
The phase IV clinical study analyzes which people take Digoxin and have Acute kidney failure. It is created by eHealthMe based on reports of 83,779 people who have side effects when taking Digoxin from the FDA, and is updated regularly.
Is eHealthme a substitute for medical advice?
DISCLAIMER: All material available on eHealthMe.com is for informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment provided by a qualified healthcare provider. All information is observation-only. Our phase IV clinical studies alone cannot establish cause-effect relationship. Different individuals may respond to medication in different ways. Every effort has been made to ensure that all information is accurate, up-to-date, and complete, but no guarantee is made to that effect. The use of the eHealthMe site and its content is at your own risk.
Can you use a supplement label on pill bottles?
You can use the report to supplement drug labels on your pill bottles or discuss it with your doctor, to ensure that all drug risks and benefits are fully discussed and understood.
How long does digoxin take to get steady state?
A steady state will be achieved after five cycles of the drug half-life (T1/2ß), which is approximately 7 to 10 days in the average subject.
Why are cardiac glycosides important?
Cardiac glycosides have important positive inotropic, neurohormonal, and electrophysiologic actions, which are the basis for its use in two clinical situations: heart failure due to systolic dysfunction, and in certain supraventricular tachyarrhythmias. The ability of digoxin to reduce sympathetic activation has also been recognized.
Is digoxin used for heart failure?
The use of digoxin primarily for heart failure is discussed separately. (See "Secondary pharmacologic therapy in heart failure with reduced ejection fraction (HFrEF) in adults", section on 'Digoxin' .)
Is digoxin a glycoside?
As digoxin is now the only cardiac glycoside available in most countries, the method of initiating therapy with digoxin for patients with atrial fibrillation is presented here. Recommendations regarding the use of digoxin in the management of heart failure or arrhythmias are discussed separately.
Can digoxin be taken intravenously?
For maximal early benefits in treating tachyarrhythmias, digoxin requires loading doses, which can be administered intravenously or orally. While two cardiac glycosides (digoxin and digitoxin) were previously used, digitoxin has not been widely available since the 1980s.
Usual Adult Dose for Atrial Fibrillation
Total loading dose: Administer one-half the total loading dose initially (all formulations), then give one-fourth the total loading dose every 6 to 8 hours for two doses (IV and tablets), or give additional fractions every 4 to 8 hours (oral solution). -IV: 8 to 12 mcg/kg -Tablets: 10 to 15 mcg/kg -Oral solution: 10 to 15 mcg/kg Maintenance dose: -IV: 2.4 to 3.6 mcg/kg once a day -Tablets: 3.4 to 5.1 mcg/kg once a day -Oral solution: 3.0 to 4.5 mcg/kg once a day Comments: -IM administration is not recommended due to associated pain and muscle necrosis.
Usual Adult Dose for Congestive Heart Failure
Total loading dose: Administer one-half the total loading dose initially (all formulations), then give one-fourth the total loading dose every 6 to 8 hours for two doses (IV and tablets), or give additional fractions every 4 to 8 hours (oral solution). -IV: 8 to 12 mcg/kg -Tablets: 10 to 15 mcg/kg -Oral solution: 10 to 15 mcg/kg Maintenance dose: -IV: 2.4 to 3.6 mcg/kg once a day -Tablets: 3.4 to 5.1 mcg/kg once a day -Oral solution: 3.0 to 4.5 mcg/kg once a day Comments: -IM administration is not recommended due to associated pain and muscle necrosis.
Usual Pediatric Dose for Congestive Heart Failure
Total loading dose: Administer one-half the total loading dose initially (all formulations), then give one-fourth the total loading dose every 6 to 8 hours for two doses (IV and tablets), or give additional fractions every 4 to 8 hours (oral solution). -Premature: IV: 15 to 25 mcg/kg; Oral solution: 20 to 30 mcg/kg -Full-term: IV: 20 to 30 mcg/kg; Oral solution: 25 to 35 mcg/kg -One month to 2 years: IV: 30 to 50 mcg/kg; Oral solution: 35 to 60 mcg/kg -Two to five years: IV: 25 to 35 mcg/kg; Oral solution: 30 to 45 mcg/kg -Five to ten years: IV: 15 to 30 mcg/kg; Oral solution: 20 to 35 mcg/kg; Tablets: 20 to 45 mcg/kg -Greater than 10 to less than 18 years: IV: 8 to 12 mcg/kg; Oral solution: 10 to 15 mcg/kg; Tablets: 10 to 15 mcg/kg Maintenance dose: -Premature: IV: 1.9 to 3.1 mcg/kg twice a day; Oral solution: 2.3 to 3.9 mcg/kg twice a day -Full-term: IV: 3 to 4.5 mcg/kg twice a day; Oral solution: 3.8 to 5.6 mcg/kg twice a day -One month to 2 years: IV: 4.5 to 7.5 mcg/kg twice a day; Oral solution: 5.6 to 9.4 mcg/kg twice a day -Two to five years: IV: 3.8 to 5.3 mcg/kg twice a day; Oral solution: 4.7 to 6.6 mcg/kg twice a day -Five to ten years: IV: 2.3 to 4.5 mcg/kg twice a day; Oral solution: 2.8 to 5.6 mcg/kg twice a day; Tablets: 3.2 to 6.4 mcg/kg twice a day -Greater than 10 to less than 18 years: IV: 2.4 to 3.6 mcg/kg once a day; Oral solution: 3 to 4.5 mcg/kg once a day; Tablets: 3.4 to 5.1 mcg/kg once a day Comments: -IM administration is not recommended due to associated pain and muscle necrosis.
Renal Dose Adjustments
For recommended maintenance doses according to lean body weight and renal function, the manufacturer product information should be consulted.
Dose Adjustments
This drug should be used at the lowest effective dose in order to achieve therapeutic efficacy and minimize side effects. Switching from IV to Oral: IV dose (mcg) x 1.25 = Oral dose (mcg) Therapeutic drug monitoring/range: 0.5 to 2 ng/mL; some patients with atrial fibrillation may require 2 to 4 ng/mL.
Precautions
NARROW THERAPEUTIC INDEX: -This drug should be considered a narrow therapeutic index (NTI) drug as small differences in dose or blood concentrations may lead to serious therapeutic failures or adverse drug reactions. Recommendations: - Generic substitution should be done cautiously, if at all, as current bioequivalence standards are generally insufficient for NTI drugs. -Additional and/or more frequent monitoring should be done to ensure receipt of an effective dose while avoiding unnecessary toxicities. Safety and efficacy have not been established for the tablet formulation in patients younger than 5 years. Consult WARNINGS section for additional precautions..
Other Comments
Administration advice: -Parenteral administration should be used only if rapid digitalization is needed or the drug cannot be tolerated orally. -Inject over 5 minutes or longer and avoid bolus administration. -If tuberculin syringes are used to measure very small doses, do not flush the syringe with the parenteral solution after the syringe contents are expelled into an indwelling vascular catheter to avoid over administration of digoxin. Storage requirements: Protect from light. Reconstitution/preparation techniques: May be administered undiluted or diluted with a 4-fold or greater volume of sterile water for injection, 0.9% sodium chloride injection, or 5% dextrose injection. IV compatibility: Mixing with other drugs in the same container or simultaneous administration in the same IV line is not recommended. General: In patients receiving diuretics with or without an angiotensin-converting enzyme (ACE) inhibitor, the withdrawal of this drug has been shown to result in clinical deterioration. Monitoring: -Drug toxicity: Serum levels of this drug just before the next scheduled dose or at least 6 hours after the last dose. -Metabolic: Serum electrolytes periodically. -Renal: Serum creatinine periodically. Patient advice: -Advise patients to contact their doctor or a health care professional if they experience nausea, vomiting, persistent diarrhea, confusion, weakness, or visual disturbances (including blurred vision, green-yellow color disturbances, halo effect) as these could be signs that the dose is too high. -Advise parents or caregivers that the symptoms of digoxin toxicity in pediatric patients may include weight loss, failure to thrive in infants, abdominal pain, and behavioral disturbances. -Instruct the patients to monitor and record their heart rate and blood pressure daily. -For the oral solution, instruct patients to use the calibrated dropper and to avoid less precise measuring tools such as teaspoons.
