DIGOXIN

Indications & Dose:

Rapid digitalisation, for atrial fibrillation or flutter

• BY MOUTH

 Adult: 0.75–1.5 mg in divided doses, dose to be given over 24 hours, reduce dose in the elderly

 Maintenance, for atrial fibrillation or flutter l

• BY MOUTH

Adult: Maintenance 125–250 micrograms daily, dose according to renal function and initial loading dose, reduce dose in the elderly

Heart failure (for patients in sinus rhythm

• BY MOUTH

Adult: 62.5–125 micrograms once daily, reduce dose in the elderly

Emergency loading dose, for atrial fibrillation or flutter

• INITIALLY BY INTRAVENOUS INFUSION

Adult: Loading dose 0.75–1 mg, to be given over at least 2 hours, then (by mouth) maintenance, loading dose is rarely necessary, maintenance dose to be started on the day following the loading dose, reduce dose in the elderly

DOSE EQUIVALENCE AND CONVERSION

% Dose may need to be reduced if digoxin (or another cardiac glycoside) has been given in the preceding 2 weeks.

When switching from intravenous to oral route may need to increase dose by 20–33% to maintain the same plasma-digoxin concentration

Contraindications:

Ventricular tachycardia, ventricular fibrillation.

Side Effects:

Cautions:

Precautions:

Interaction:

Drugs

Alprazolam, amiodarane, diltiazem, verapamil, bepri-dil, nitrendipine, quinidine, carvedilol, cyclosporine, erythromycin and tetracyclines (change in bacterial flora causing effect may persist for months), hydroxy-chloroquine, NSALDs, azole antifungals, omepra-zole, lansoprazole, propafenone, quinine, spironolactone, tacrolimus: Increased digoxin levels

Amphotericin B diuretics: Enhanced digitalis toxicity secondary to drug-induced hypokalemia

Beta-blockers: Potentiation of bradycardia

Calcium (IV): Digitalis toxicity

Ch– arcoal: Reduced digitalis Levels Cholestyramine, Kaolo-pectin (digoxin tablets only) neomycin, penicillamine, rifampin, sulfasalazine: Reduced digitalis levels

Cyclophosphamide: Impaired digaxin (especially tablets) absorption; digitoxin not affected

Metoclopromide, cisapride: Reduced digitalis levels by slowly dissolving digoxin tablets only (Lanoxintablets and capsules not affected)

Succinylcholine: Increased arrhythmias.

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Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: