Precautions
For rapid effect, a larger initial loading/digitalizing dose should be given in several divided doses over 12-24 hr. Maintenance doses are determined for digoxin by renal function. All dosing must be evaluated by individual response. In general, doses required for atrial arrhythmias are higher than those for inotropic effect.
How is the initial dose of digoxin dose determined?
Digoxin belongs to the class of medicines called digitalis glycosides. It is used to improve the strength and efficiency of the heart, or to control the rate and rhythm of the heartbeat.
What is digoxin?
Concurrent ingestion of a high-fiber meal may ↓ absorption. Administer digoxin 1 hr before or 2 hrs after such a meal. For rapid effect, a larger initial loading/digitalizing dose should be given in several divided doses over 12–24 hr. Maintenance doses are determined for digoxin by renal function.
What is the best time of day to take digoxin?
Initial: 400 to 600 mcg of digoxin capsules generally produces a detectable effect in 0.5 to 2 hours with a maximal effect in 2 to 6 hours. Additional doses of 100 to 300 mcg may be given cautiously at 6 to 8 hour intervals until clinical evidence of an adequate effect is noted.
How long does it take for digoxin to work?
How is digoxin administered?
Administration of digoxin injection: Each dose should be given by intravenous infusion over of 10 - 20 minutes. The total loading dose should be administered in divided doses with approximately half of the total dose given as the first dose and further fractions of the total dose given at intervals of 4 - 8 hours.
Is digoxin oral or IV?
Parenteral administration of digoxin should be used only when the need for rapid digitalization is urgent or when the drug cannot be taken orally. Intramuscular injection can lead to severe pain at the injection site, thus intravenous administration is preferred.
Is digoxin given sublingual?
The present data suggested that the sublingual administration of the rapid dissolving form of gamma-cyclodextrin complex may be useful for improving the bioavailability of digoxin due to the prevention of acid hydrolysis in stomach and the enhancement of drug absorption rate.
Where is digoxin administered?
IM Administer deep into gluteal muscle and massage well to reduce painful local reactions. Do not administer more than 2 mL of digoxin in each IM site. IM administration is not generally recommended.
Can digoxin be given orally?
Digoxin oral tablet is available as both a generic and brand-name drug. Brand name: Lanoxin. Digoxin is also available as an oral solution. Digoxin oral tablet is used to treat atrial fibrillation, mild to moderate heart failure in adults, and heart failure in children.
What is digoxin IV used for?
Digoxin injection is given in combination with a diuretic (water pill) and an angiotensin-converting enzyme (ACE) inhibitor to treat heart failure in adults and children. It is also used to treat adults with atrial fibrillation (a heart rhythm problem).
Is sublingual or buccal better?
In conclusion, buccal nitroglycerin seems to be more efficacious than sublingual nitroglycerin. The explanation is probably that the two formulations are comparable in the treatment of acute anginal attacks, while buccal nitroglycerin has a more pronounced prophylactic effect due to its longer duration of action.
Why is sublingual better than oral?
One reason for selecting the sublingual route is to avoid drug destruction. Because gastric acid and intestinal and hepatic enzymes are bypassed, sublingual absorption can be more efficient overall for certain drugs than intestinal uptake. The onset of drug effect may also be quicker than with oral ingestion.
Why does sublingual avoid first pass?
Alternative routes of administration, such as insufflation, suppository, intravenous, intramuscular, inhalational aerosol, transdermal, or sublingual, avoid the first-pass effect because they allow drugs to be absorbed directly into the systemic circulation.
What are two 2 contraindications for the use of digoxin?
Digoxin is contraindicated in the following conditions[5]: Acute myocardial infarction. Hypersensitivity to the drug. Ventricular fibrillation.
What should you check before administering digoxin?
Check your pulse before you take your digoxin. If your pulse is under 60 beats per minute, wait 5 minutes. Then check your pulse again. If it's still under 60, call your healthcare provider.
Why do you have to take an apical pulse before giving digoxin?
A nurse should assess the apical pulse for a full minute before administering digoxin due to its positive inotropic action (it increases contractility, stroke volume, and, thus, cardiac output), negative chronotropic action (it decreases heart rate), and negative dromotropic action (it decreases electrical conduction ...
How long does oral digoxin take to work?
Response and effectiveness. Although some effects of digoxin may be noticed soon after taking, it can take up to 7-14 days or longer after drug initiation or a dosage change for the full effects to be seen.
When do you administer digoxin?
You can take digoxin with or without food, but it's best to take it at the same time each day. Most people take it in the morning after breakfast. You'll usually take it once a day. Swallow the tablets whole with a drink of water.
How do you start taking digoxin?
Slow digoxin loading — Slow oral digitalization, generally preferred for most patients, can be achieved by starting a maintenance dose of 0.125 to 0.25 mg daily. 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.
Does IV digoxin affect blood pressure?
In patients with atrial fibrillation and HFrEF, digoxin is advantageous because, unlike other agents (e.g., β-blockers, calcium-channel blockers), it does not have negative inotropic effects, nor does it lower blood pressure.
Before Taking This Medicine
You should not use digoxin if you are allergic to it, or if you have ventricular fibrillation (a heart rhythm disorder of the ventricles, or lower...
How Should I Take Digoxin?
Take digoxin exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller...
What Happens If I Miss A Dose?
Take the missed dose as soon as you remember. Skip the missed dose if your next dose is less than 12 hours away. Do not take extra medicine to make...
What Happens If I Overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of digoxin can be fatal.
What Should I Avoid While Taking Digoxin?
Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Digoxin overdose can occur more easily i...
Digoxin Dosing Information
Usual Adult Dose of Digoxin for Congestive Heart Failure:Rapid Digitalization with a Loading Dose:Peak digoxin body stores of 8 to 12 mcg/kg genera...
What Other Drugs Will Affect Digoxin?
Other drugs may interact with digoxin, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your heal...
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.
How long after eating can you take digoxin?
Concurrent ingestion of a high-fiber meal may ↓ absorption. Administer digoxin 1 hr before or 2 hrs after such a meal.
How much elixir is absorbed?
Absorption: 60–80% absorbed after oral administration of tablets; 70–85% absorbed after administration of elixir; 80% absorbed from IM sites (IM route not recommended due to pain/irritation).
Does amiodarone cause digoxin?
Amiodarone may ↑ levels and lead to toxicity; ↓ digoxin dose by 50%.
Is Geri a toxic drug?
Geri: Very sensitive to toxic effects; dose adjustments required for age-related ↓ in renal function and body weight.
Is digoxin toxic to older adults?
Geri: Older adults are at increased risk for toxic effects of digoxin (on Beers list) due to age-related decreased renal clearance; may exist even when serum creatinine levels are normal. Digoxin requirements in older adult may change and a formerly therapeutic dose can become toxic.
How is digoxin administered?
Digoxin is administered orally, intravenously, or intramuscularly. After administration, digoxin undergoes a 6- to 8-hour distribution phase in which serum concentrations fall more rapidly followed by a slower elimination phase. Digoxin distributes throughout the body tissues, with the highest concentrations found in the heart, kidneys, intestine, liver, stomach, and skeletal muscle. Small amounts can be found in the brain. Since digoxin concentrates in the tissues, it has a large volume of distribution. Early serum concentrations do not represent digoxin concentrations at the sites of action; however, an equilibrium is obtained between serum and tissue concentrations at steady-state, post-distribution with chronic digoxin therapy. The presence of congestive heart failure slows the rate at which steady-state distribution is achieved. Approximately 25% of the drug is plasma protein-bound. Digoxin crosses the placenta, and maternal and fetal plasma concentrations of the drug are equal.
How is digoxin absorbed?
In general, digoxin is rapidly absorbed from the GI tract following an oral dose. In approximately 10% of patients, 40% or more of an orally ingested digoxin is converted to inactive metabolites, such as dihydrodigoxin, in the gut by colonic bacteria.
How to reduce digoxin?
Reduce digoxin concentrations by decreasing the digoxin dose by approximately 15-30% or by modifying the dosing frequency and continue monitoring. Anticholinergics, because of their ability to cause tachycardia, can also antagonize the beneficial actions of digoxin in atrial fibrillation/flutter.
Is digoxin dangerous during pregnancy?
Published retrospective clinical studies and case reports with digoxin use in pregnant women have not identified a drug-as sociated risk of major birth defects, miscarriage, or adverse fetal or maternal outcomes. Digoxin has been shown to cross the placenta and is found in amniotic fluid. Monitor neonates exposed to digoxin in utero for signs and symptoms of digoxin toxicity, including vomiting and cardiac arrhythmias. Digoxin requirements may increase during pregnancy and decrease in the postpartum period; monitor serum digoxin concentrations during pregnancy and the postpartum period. The risk of arrhythmia may be increased during labor and obstetric delivery; monitor patients continually during labor and delivery. Untreated underlying maternal conditions (e.g., heart failure and atrial fibrillation) during pregnancy pose a risk to the mother and fetus, including maternal or fetal death. Pregnant women with heart failure are at increased risk for preterm birth, and pregnant women with atrial fibrillation are at an increased risk of delivering a low birth weight infant. [28272]
Does amobarbital increase digoxin?
Amobarbital: (Moderate) Hepatic enzyme inducing drugs, such as barbiturates, can accelerate the metabolism of digoxin, decreasing its serum concentrations. It is recommended that digoxin concentrations be monitored if used with barbiturates.
Does magnesium trisilicate reduce digoxin?
Aluminum Hydroxide; Magnesium Trisilicate: (Moderate) Concurrent administration of liquid antacid formulations of aluminum hydroxide can decrease absorption of digoxin and other cardiac glycosides and reduce their plasma concentration. Steady state concentrations of digoxin are not lowered following administration of tablet formulations of aluminum hydroxide. Doses of liquid aluminum hydroxide and cardiac glycosides should be spaced 1 to 2 hours apart. The manufacturer of digoxin recommends measuring serum digoxin concentrations prior to initiation of an antacid. Continue monitoring during concomitant treatment and increase the digoxin dose by 20 to 40% as necessary.
Can digoxin be used intramuscularly?
Intramuscular administration of digoxin causes considerable pain at the injection site and is generally not recommended. If IM administration must be used, inject deeply into a large muscle mass, and massage area after administration.
How long should digoxin be given?
For rapid effect, a larger initial loading/digitalizing dose should be given in several divided doses over 12-24 hr. Maintenance doses are determined for digoxin by renal function. All dosing must be evaluated by individual response. In general, doses required for atrial arrhythmias are higher than those for inotropic effect.
How much digitalizing dose is given for a 24 month old?
IV: (Children 1-24 mo): Digitalizing dose- 30-50 mcg/kg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 6-12 hr intervals.
How much po is given?
PO: (Adults) Digitalizing dose- 0.75-1.5 mg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 6-12 hr intervals. Maintenance dose- 0.125-0.5 mg/day depending on patient's lean body weight, renal function, and serum level.
What is Digoxin (Lanoxin)?
Digoxin (Lanoxin) is a medicine used for various heart conditions including arrhythmias and congestive heart failure. It is used to improve the strength and efficiency of the heart, or to control the rate and rhythm of the heartbeat. This leads to better circulation (blood flow) and less swelling of hands and ankles.
Can you give digoxin to a child?
Give this medication only as directed, and do not stop unless directed to stop by your child's doctor. Do not give any other medicine, prescription or over-the-counter (OTC), without first talking to your child's doctor. Measure the oral liquid medicine with a marked measuring spoon or medicine cup. While your child is taking digoxin, the doctor ...
Is Digoxin a liquid or IV?
This leads to better circulation (blood flow) and less swelling of hands and ankles. Digoxin is available in a tablet, liquid and in intravenous (IV) form. This medicine is also called digitalis. Special Instructions. Give this medication only as directed, and do not stop unless directed to stop by your child's doctor.
