Classifications: cardiac glycoside; antiarrhythmic; Therapeutic: cardiac glycoside; antiarrhythmic
Pregnancy Category: C
0.05 mg, 0.1 mg, 0.2 mg capsules; 0.125 mg, 0.25 mg, 0.5 mg tablets; 0.05 mg/mL elixir; 0.25 mg/mL, 0.1 mg/mL injection
Widely used cardiac glycoside of Digitalis lanata. Acts by increasing the force and velocity of myocardial systolic contraction (positive inotropic effect). It also decreases
conduction velocity through the atrioventricular node. Action is more prompt and less prolonged than that of digitalis and
Increases the contractility of the heart muscle (positive inotropic effect). Has antiarrhythmic properties that result from
its effects on the AV node.
Rapid digitalization and for maintenance therapy in CHF, atrial fibrillation, atrial flutter, paroxysmal atrial tachycardia.
Digitalis hypersensitivity, sick sinus syndrome, Wolff-Parkinson-White syndrome; ventricular fibrillation, ventricular tachycardia
unless due to CHF. Full digitalizing dose not given if patient has received digoxin during previous week or if slowly excreted
cardiotonic glycoside has been given during previous 2 wk.
Renal insufficiency, hypokalemia, advanced heart disease, cardiomyopathy, acute MI, incomplete AV block, cor pulmonale;
hypothyroidism; lung disease; premature and immature infants, children, older adults, or debilitated patients; pregnancy
Route & Dosage
|Digitalizing Dose (Give ? dose initially followed by 1/4 at 812 h intervals)
Adult: PO 0.751.5 mg IV 0.51 mg
Child: IV 210 y, 2035 mcg/kg; >10 y, 812 mcg/kg PO 210 y, 3040 mcg/kg; >10y, 1015 mcg/kg
Infant: IV 3050 mcg/kg PO 3560 mcg/kg
Neonate: IV Preterm, 1525 mcg/kg; Full-term, 2030 mcg/kg
Adult: PO/IV 0.10.375 mg/d
Child: PO/IV <2 y, 7.59 mcg/kg/d; 210 y, 67.5 mcg/kg/d; >10 y, 0.1250.25 mg/d
Neonate: IV 48 mcg/kg/d
- Give without regard to food. Administration after food may slightly delay rate of absorption, but total amount absorbed
is not affected.
- Crush and mix with fluid or food if patient cannot swallow it whole.
PREPARE: Direct: Give undiluted or diluted in 4 mL of sterile water, D5W, or NS (less diluent may cause precipitation).
ADMINISTER: Direct: Give each dose over at least 5 min.
INCOMPATIBILITIES Solution/additive: Dobutamine. Y-site: Amiodarone, amphotericin B cholesteryl complex, fluconazole, foscarnet, propofol.
- Store tablets, elixir, and injection solution at 25° C (77° F) or at 15°30° C (59°86°
Adverse Effects (≥1%)CNS: Fatigue
, muscle weakness, headache, facial neuralgia
, mental depression
, paresthesias, hallucinations, confusion, drowsiness,
agitation, dizziness. CV:
Arrhythmias, hypotension, AV block. Special Senses:
Visual disturbances. GI:
Diaphoresis, recurrent malaise
Interactions Drug: antacids
, cholestyramine, colestipol
, amphotericin B, laxatives
, sodium polystyrene sulfonate
may cause hypokalemia, increasing the risk of digoxin toxicity
; calcium IV
may increase risk of arrhythmias if administered together with digoxin; quinidine, verapamil, amiodarone, flecainide
significantly increase digoxin
levels, and digoxin
dose should be decreased by 50%; erythromycin
may increase digoxin
may potentiate arrhythmogenic effects; nefazodone
may increase digoxin
High fiber intake may decrease absorption. Herbal: Ginseng
increase digoxin toxicity
; ma huang, ephedra
may induce arrhythmias; St. John's wort
70% PO tablets; 90% PO liquid and capsules. Onset:
12 h PO; 530 min IV
68 h PO; 15 h IV
34 d in fully digitalized patient. Distribution:
Widely distributed; tissue
levels significantly higher than plasma
levels; crosses placenta. Metabolism:
14% in liver. Elimination:
8090% by kidneys; may appear in breast milk. Half-Life:
Assessment & Drug Effects
- Take apical pulse for 1 full min, noting rate, rhythm, and quality before administering drug.
- Withold medication and notify physician if apical pulse falls below ordered parameters (e.g., <50 or 60/min in adults and
<60 or 70/min in children).
- Be familiar with patient's baseline data (e.g., quality of peripheral pulses, blood pressure, clinical symptoms, serum electrolytes,
creatinine clearance) as a foundation for making assessments.
- Lab tests: Baseline and periodic serum digoxin, potassium, magnesium, and calcium. Draw blood samples for determining plasma
digoxin levels at least 6 h after daily dose and preferably just before next scheduled daily dose.
- Monitor for S&S of drug toxicity: In children, cardiac arrhythmias are usually reliable signs of early toxicity. Early indicators
in adults (anorexia, nausea, vomiting, diarrhea, visual disturbances) are rarely initial signs in children.
- Monitor I&O ratio during digitalization, particularly in patients with impaired renal function. Also monitor for edema daily
and auscultate chest for rales.
- Monitor serum digoxin levels closely during concurrent antibioticdigoxin therapy, which can precipitate toxicity because
of altered intestinal flora.
- Observe patients closely when being transferred from one preparation (tablet, elixir, or parenteral) to another; when tablet
is replaced by elixir potential for toxicity increases since ≥30% of
drug is absorbed.
Patient & Family Education
- Report to physician if pulse falls below 60 or rises above 110 or if you detect skipped beats or other changes in rhythm,
when digoxin is prescribed for atrial fibrillation.
- Suspect toxicity and report to physician if any of the following occur: Anorexia, nausea, vomiting, diarrhea, or visual disturbances.
- Weigh each day under standard conditions. Report weight gain >1 kg (2 lb)/d.
- Take digoxin PRECISELY as prescribed. Do not skip or double a dose or change dose intervals, and take it at same time each day.
- Do not to take OTC medications, especially those for coughs, colds, allergy, GI upset, or obesity, without prior approval
- Continue with brand originally prescribed unless otherwise directed by physician.