Digoxin

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Generic Name of Digoxin - Learn More

Digoxin

Digoxin Precaution - What You Need to Know

Digoxin is a cardiac glycoside used to treat heart failure and certain types of arrhythmias, particularly atrial fibrillation. While effective, it requires careful use and monitoring to avoid potentially serious side effects, especially in patients with certain conditions.
- Pregnancy and breastfeeding: Digoxin is classified as a pregnancy category C drug, meaning it should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is excreted in breast milk, so breastfeeding mothers should weigh the benefits and risks before using it.
- Renal impairment: Digoxin is primarily excreted by the kidneys, so patients with renal dysfunction need dose adjustments to prevent toxicity. Careful monitoring of renal function is essential in these cases.
- Electrolyte imbalances: Hypokalemia, hypomagnesemia, and hypercalcemia can increase the risk of digoxin toxicity. Serum electrolytes should be monitored regularly, especially in patients on diuretics or those with kidney disease.
- Monitoring parameters: Digoxin levels should be monitored to ensure they stay within the therapeutic range (typically 0.5-2.0 ng/mL). Symptoms of toxicity, such as nausea, vomiting, visual disturbances, and arrhythmias, should be watched for, and therapy should be adjusted accordingly.
- Misuse and dependency: Although not habit-forming, misuse of digoxin due to improper dosing can lead to life-threatening arrhythmias and other complications. Regular check-ups and adherence to prescribed doses are vital.

Digoxin Indication - Uses and Benefits

Digoxin is primarily used to treat heart failure and atrial fibrillation.
- Heart failure: Digoxin helps increase the force of heart muscle contractions and improves the heart's pumping efficiency, which is particularly beneficial in heart failure patients. It is often used in combination with other heart failure medications, such as ACE inhibitors or diuretics.
- Atrial fibrillation and atrial flutter: Digoxin controls ventricular rate in patients with atrial fibrillation or atrial flutter by slowing down conduction through the AV node.
- Off-label uses: Digoxin is sometimes used off-label for other arrhythmias, including certain forms of supraventricular tachycardia (SVT), but this is less common.

Digoxin Contraindications - Important Warnings

There are several conditions in which digoxin should be avoided or used with extreme caution:
- Ventricular fibrillation: Digoxin should not be used in patients with ventricular fibrillation because it can worsen the arrhythmia.
- Hypersensitivity: A known allergy or hypersensitivity to digoxin or any of its excipients is a contraindication.
- Severe renal impairment: In patients with severe renal dysfunction or anuria, digoxin may accumulate to toxic levels, and dosing must be adjusted based on kidney function.
- Acute myocarditis or pericarditis: Acute inflammation of the heart muscle or surrounding tissues can worsen the effects of digoxin and increase the risk of arrhythmias.
- Electrolyte disturbances: Significant electrolyte imbalances, particularly hypokalemia or hypercalcemia, can increase the risk of digoxin toxicity and should be corrected before initiating therapy.
- Thyroid disorders: In hyperthyroid patients, digoxin’s effects may be exaggerated, while in hypothyroid patients, the drug’s effectiveness may be reduced.

Digoxin Side Effects - What to Expect

While effective, digoxin can lead to a range of side effects, particularly if blood levels exceed the therapeutic range.
- Common side effects:
- Nausea and vomiting
- Diarrhea
- Fatigue and weakness
- Dizziness or lightheadedness
- Serious side effects:
- Digoxin toxicity: Symptoms of toxicity include confusion, visual disturbances (e.g., yellow-green halos around lights), irregular heart rhythms, and gastrointestinal symptoms (nausea, vomiting).
- Cardiac arrhythmias: Although used to treat arrhythmias, digoxin can also cause life-threatening arrhythmias, especially in overdose or toxicity.
- Electrolyte disturbances: Imbalances in potassium, calcium, and magnesium levels can worsen side effects and toxicity. Hypokalemia is particularly concerning.
- Management: Regular blood tests to monitor digoxin levels and electrolytes are essential. In case of toxicity, digoxin should be discontinued immediately, and patients may require treatment with digoxin-specific antibody (ovine-derived Digibind) in severe cases.

Digoxin Pregnancy Category ID - Safety Information

3

Digoxin Mode of Action - How It Works

Digoxin works by inhibiting the sodium-potassium ATPase pump, which is responsible for maintaining the balance of sodium and potassium in cardiac cells. This inhibition increases intracellular calcium levels, which enhances contractility (positive inotropic effect).
- Pharmacodynamics: The increased calcium levels lead to enhanced myocardial contractility, which helps improve cardiac output in heart failure. Additionally, digoxin slows conduction through the atrioventricular (AV) node, which helps control ventricular rate in atrial fibrillation and atrial flutter.
- Pharmacokinetics: Digoxin is well-absorbed from the gastrointestinal tract, with bioavailability typically ranging from 60-80%. It is widely distributed throughout the body and is eliminated primarily by the kidneys. The drug has a half-life of 36-48 hours in patients with normal renal function, but it can be prolonged in those with renal impairment.
- Benefits: By improving cardiac output and controlling heart rate, digoxin can significantly alleviate symptoms of heart failure and arrhythmias, improving patient quality of life.

Digoxin Drug Interactions - What to Avoid

Digoxin has numerous drug interactions that can increase the risk of side effects or decrease its therapeutic effectiveness.
- Other cardiac drugs: Drugs like beta-blockers, calcium channel blockers, and antiarrhythmic agents (e.g., amiodarone) can interact with digoxin by either enhancing its effects (leading to bradycardia or toxicity) or by affecting its clearance. The use of these drugs together should be monitored closely.
- Diuretics: Diuretics (e.g., furosemide, hydrochlorothiazide) may cause electrolyte imbalances, particularly low potassium and magnesium levels, which increase the risk of digoxin toxicity. Supplementation with potassium or magnesium may be necessary.
- Antibiotics: Some antibiotics, such as erythromycin and clarithromycin, can increase digoxin levels by inhibiting its metabolism. Dose adjustments may be needed if these antibiotics are prescribed.
- Other interactions: Drugs that alter renal function (e.g., NSAIDs, ACE inhibitors) can also affect digoxin levels. When combining digoxin with these drugs, close monitoring of kidney function and digoxin serum levels is important.
- Food and lifestyle: High-fiber foods and antacids containing aluminum or magnesium can reduce the absorption of digoxin, so patients should avoid taking these concurrently with the drug.

Digoxin Adult Dose - Recommended Dosage

The usual adult dose of digoxin for heart failure or atrial fibrillation is:
- Loading dose: 0.5 to 1 mg orally, usually divided into smaller doses (e.g., 0.25 mg every 6-8 hours for 24 hours) to reach therapeutic levels quickly.
- Maintenance dose: After the loading dose, the typical maintenance dose is 0.125 to 0.25 mg daily, depending on renal function, age, and body weight. The dose is adjusted based on the patient’s response and serum digoxin levels.
- Special considerations: For elderly patients or those with renal impairment, lower doses (e.g., 0.125 mg) may be necessary to avoid toxicity. Digoxin should be taken at the same time each day to maintain consistent blood levels.
- Monitoring: Serum digoxin levels should be monitored regularly, especially during the initial dosing phase, to ensure they stay within the therapeutic range (0.5-2.0 ng/mL).

Digoxin Child Dose - Dosage for Children

Digoxin is used in children for treating certain types of heart conditions, such as congenital heart disease or arrhythmias, but the dosing differs from adults and must be carefully managed.
- Typical dose: For children, the dose is generally based on body weight, and it is often calculated as 10-15 mcg/kg/day divided into two or more doses.
- Infants and children: For infants under 2 years old, digoxin doses are typically given as 0.03-0.05 mg/kg/day, divided into two doses.
- Monitoring: Children on digoxin therapy should have regular monitoring of serum digoxin levels, renal function, and electrolytes. Special caution is required in infants, as they are more sensitive to digoxin's effects. Regular pediatric follow-up is necessary to adjust dosing and avoid toxicity.

Digoxin Renal Dose - Dosage for Kidney Conditions

Because digoxin is primarily eliminated by the kidneys, renal function plays a critical role in determining the appropriate dose.
- Renal impairment: For patients with reduced renal function (e.g., creatinine clearance <50 mL/min), the maintenance dose of digoxin should be reduced by 50%. In severe renal impairment, additional reductions may be required, and patients should be monitored closely for toxicity.
- Monitoring: Regular monitoring of kidney function (serum creatinine and creatinine clearance) is essential, especially in older adults or those with preexisting renal conditions. The dosing interval may also need to be adjusted based on renal function.
- Hemodialysis: Digoxin is not significantly removed by hemodialysis, so dialysis patients still require careful monitoring of serum levels.