DIGOXIN

DIGOXIN
Digoxin is a poisonous compound found in foxglove and plant it is a steroid glycoside and is
used in small doses as a cardiac stimulant.
TRADE NAME :Lanoxin, Lanoxicap, Digitek
GENERIC NAME: Digoxin
PHARMACOLOGICAL CLASS: Cardiac glycoside, cardiotonic
THERAPEUTIC CLASS:Antidysrythmic, ionotropic agent
HOW IT IS SUPPLIED: Tablets 0.0625mg, 0.125mg,0.1875mg,0.25mg
Capsules:100mcg(0.1mg), 200mcg(0.2mg)
Oral solution 0.05mg/ml
Vial 0.1mg/ml, 0.25/ml
PREGNANCY CATEGORY C: Animal studies failed to reveal evidence of teratogenicity.It has

been used successfully to treat maternal congestive heart failure and arrhythmias and fetal
arrhythmias throughout gestation without report of fetal harm. However, digoxin should be given
in pregnancy only when the benefit outweighs the risk. It is excreted into human milk, however,
nursing infant exposure is limited.
ROUTE OF ADMINISTRATION: Oral, intravenous, intramuscular.
INDICATIONS
 Congestive heart failure

 Atrial fribrillation
CONTRAINDICATIONS
 Allergy to digitalis
 Ventricular tarchycardia
 Ventricular fribrillation
 Heart block
 Sick sinus syndrome
 Acute myocardial infarction
 Renal insufficiency
 Electrolyte abnormality (decreased potassium, increased calcium,decreased magnesium)
 Thyroid disease
DOSAGE
ADULTS WITH CONGESTIVE HEART FAILURE: According to ACCF/AHA guidelines, a

loading dose to initiate digoxin therapy in patients with heart failure is not necessary but you can
give 0.125- 0.25mg per os or IV daily, higher doses including 0.375-0.5mg/day( rarely needed) .
Use lower end of dosing (0.125mg/day) in patients with impaired renal function.
ATRIAL FRIBRILLATION: Loading dose ( IV) 0.008-0.012mg/kg.
Total loading dose: administer 50% initially then cautiously give ¼ of the loading dose every 6-
8hrs twice and perform careful assessment of clinical response and toxicity before each dose.
Maintenance dose : 0.1-0.4mg/day. IM not preferred because of severe injection site reaction.
Oral: loading dose 10-15mcg/kg administer 50% initially then may cautiously give ¼ the loading
dose every 6-8hrs twice and perform careful assessment of clinical response and toxicity before
each dose. Maintenance dose: 3.4-5.1mcg/kg/day or 0.125-0.5mg/day. Dose may be increased
every 2weeks based on clinical response and toxicity.
PEADIATRICS
HEART FAILURE/ ATRIAL FRIBRILLATION
Infants and children 1-24months
Loading dose (oral):17.5-30mcg/kg, 2nd and 3rd doses-8.7-15mcg/kg every 6-8hrs for 2 doses.
Maintenance dose: 10-15mcg/kg/day every 12hrs
Loading dose(IV) 15-25mcg/kg 2nd and 3rd doses-7.5-12.5mcg/kg every 6-8hrs for 2 doses;
Maintenance : 7.5-12mcg/kg/day divided each 12hrs
2-5 years
loading dose(oral): 15-20mcg/kg 2nd and 3rd loading dose 8.75-10mcg/kg/day every6-8hrs for 2
doses. Maintenance dose:7.5-10mcg/kg/day 12hourly. For IV loading dose:12.5-17.5mcg/kg, 2nd
and 3rd doses : 6.25-8.75mcg/kg every 6-8hrs for 2 doses. Maintenance dose:6-9mcg/kg/day
divide into 12hrs.
5-10years
Loading dose (oral): 10-17.5mcg/kg, 2nd and 3rd loading doses 5-8.75mcg/kg every 6-8hrs for 2
doses.
Maintenance dose:4-8mcg/kg/day given 12hourly . For IV loading dose: 7.5-15mcg/kg 2nd and
3rd loading dose3.75-7.5mcg/kg 6-8hrs for 2 doses, Maintenance dose: 4-8mcg/kg/day divided
12hourly
10 and above <100kg
Loading dose (oral): 5-7.5mcg/kg 2nd and 3rd loading doses-2.5-3.75mcg/kg each 6-8hrs for 2
doses.Maintenance dose: 2.5-5mcg/kg/day. For IV loading dose: 4-6mcg/kg 2nd and 3rd loading
doses 2-3mcg/kg every 6-8hrs for 2 doses.Maintenance dose: 2-3mcg/kg/day
Note that Lanoxicap has greater bioavailability than standard tablet and recommended daily
dosage are only 80%of those for the tablets, therefore the 0.2mg capsule is equivalent to
0.125mg tablet and the 0.05mg capsule is equivalent to 0.0625mg.
For IV preparation, it may administered diluted or undiluted, dilute 1ml of digoxin in 4mls of
sterile water for injection,normal saline, 5% dextrose, and inject slowly 5minutes or longer.
PHARMACOLOGICAL EFFECT
Its main target is the heart, it increases the contraction of the heart muscles by inhibiting the
activity of an enzyme adenosine triphosphatase (ATPase) that controls the movement of calcium,
sodium, and potassium into the heart muscles , calcium controls the force of contraction,
therefore the inhibiting ATPase increases calcium in the heart muscles and therefore increasing
the force of contraction. Digoxin also slows electrical conduction between the atria and the
ventricle of the heart and is useful in treating abnormally rapid atrial rhythm such as atrial
fribrillation and atrial tarchycardia. During rapid atrial rhythms , electrical signals from atria
causes rapid contraction of the ventricles, which means there will be inefficient pumping of
blood containing oxygen and nutrients to the body causing symptoms like ‘weakness shortness
of breath, dizziness and chest pains. Digoxin alleviate these symptoms by blocking the electrical
conduction between the atria and the ventricles, thus slowing ventricular contraction.
ADVERSE EFFECT
CNS: headache, weakness, drowsiness,visual disturbance, mental state changes.
CV:cardiac dysrhythmias, arrhythmia in children
GI : anorexia, vomiting, diarrhea, nausea.
TOXICITY
Toxicity can occur in patients with conditions such as kidney disease, patients using
herbal substance that contain substance similar to digoxin and the use of drugs that
interact with digoxin eg: diuretics calcium channel blockers. Symptoms include:
 Lack of appetite
 Nausea
 Vomiting or diarrhea
 Headache , confusion,anxiety,or hallucination
 Restlessness, weakness, or depression
 Change in vision; blurred vision
 A fast ,slow or irregular heart beat or palpitation.
MANAGEMENT OF TOXICITY
 The primary management is by use of digoxin immune fab(ovine), it’s a drug

which is an antibody made up of anti-digoxin immunoglobulin.
 Simply discontinue digoxin therapy
 Assess the severity of toxicity and its etiology eg accidental ingestion or altered
digoxin metabolism due to diminished renal clearance
 Hydrate with IV fluids
 Oxygen support
 Whole bowel irrigation may be useful
Activated charcoal for acute ing

 NURSING CONSDERATION
 Assess patient to find out if they have allergy to digitalis preparation, renal
insufficiency.
 Do physical examination; check weight, orientation, affect, reflexes vision, pulse,
BP, cardiac auscultation, renal function test.
 Check dosage and preparation carefully
 Avoid IM injection which may be very painful
 Follow diluting instructions carefully and use diluted solution immediately
 Avoid giving with meals because it will delay absorption
 Have emergency equipment ready in case of toxicity eg cardiac monitor
 Withhold dose if pulse isless than 60bpm in adult,less than 70bpm in children,and
less than 90bpm in infants.
 Instruct patient to take digoxin at the same time each day to ensure steady-state
dosing and contact health care provider for instruction if a dose is missed.
 Teach patient and family the name ,action,administration,adverse reaction, and
toxicity effect of the drug.
 Emphasize on the importance of follow ups to determine effectiveness and to
monitor toxicity.
REFERENCES:Archiveed Drugs label
RotmensschHH,RotmenschS,Elkayam U,” management of cadiac arrhythmias during pregnancy,

concept “Drug 33(1987) 623-33
www.drugs .com
www.everydayhealth.com
Medscape. Com
www.rxlist.com
www.cvpharmacology.com/digitalis.

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DIGOXIN

TRADE NAME :Lanoxin, Lanoxicap, Digitek

GENERIC NAME: Digoxin

PHARMACOLOGICAL CLASS: Cardiac glycoside, cardiotonic

THERAPEUTIC CLASS:Antidysrythmic, ionotropic agent

HOW IT IS SUPPLIED: Tablets 0.0625mg, 0.125mg,0.1875mg,0.25mg

Oral solution 0.05mg/ml

Vial 0.1mg/ml, 0.25/ml

PREGNANCY CATEGORY C: Animal studies failed to reveal evidence of teratogenicity.It has

ROUTE OF ADMINISTRATION: Oral, intravenous, intramuscular.

 Congestive heart failure

ADULTS WITH CONGESTIVE HEART FAILURE: According to ACCF/AHA guidelines, a

ATRIAL FRIBRILLATION: Loading dose ( IV) 0.008-0.012mg/kg.

HEART FAILURE/ ATRIAL FRIBRILLATION

Infants and children 1-24months

10 and above <100kg

CNS: headache, weakness, drowsiness,visual disturbance, mental state changes.

CV:cardiac dysrhythmias, arrhythmia in children

GI : anorexia, vomiting, diarrhea, nausea.

 The primary management is by use of digoxin immune fab(ovine), it’s a drug

Activated charcoal for acute ing

REFERENCES:Archiveed Drugs label

RotmensschHH,RotmenschS,Elkayam U,” management of cadiac arrhythmias during pregnancy,

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