Names and pronunciation
(di-jox′in) Digitek, Digox, Lanoxin, Lanoxin Pediatric, Toloxin
Source page 391
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Individual generic drug information
Extracted information for digoxin only.
(di-jox′in) Digitek, Digox, Lanoxin, Lanoxin Pediatric, Toloxin
Source page 391
Func. class.: Cardiac glycoside, inotropic, antidysrhythmic
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Chem. class.: Digoxin preparation
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Do not confuse: Lanoxin/Lasix/Lonox/Lomotil/Xanax/ naloxone
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ACTION: Inhibits the sodium-potassium ATPase pump, which makes more calcium available for contractile proteins, thereby resulting in increased cardiac output (posi- tive inotropic effect); increases force of contractions; decreases heart rate (negative chronotropic effect); decreases AV conduc- tion speed
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USES: Heart failure, atrial fibrillation/ flutter
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Unlabeled uses: Paroxysmal supraven- tricular tachycardia (PSVT) treatment/ prophylaxis
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Extracted information for digoxin only.
CONTRAINDICATIONS: Hyper- sensitivity to digoxin, ventricular fibrilla- tion, ventricular tachycardia Precautions: Pregnancy, breastfeeding, geriatric patients, renal disease, acute MI, AV block, severe respiratory disease, hypo- thyroidism, sinus nodal disease, hypokale- mia, carotid sinus syndrome, second- or third-degree heart block, electrolyte distur- bances, hypertension, cor pulmonale, Wolff-Parkinson-White syndrome DOSAGE AND ROUTES—NTI • Digitalization may be done either by rapid digitalization with a loading dose over days or gradual digitalization with slow titration over weeks • Digoxin injection is often used first to achieve rapid digitalization, then switched to PO dosing for maintenance • Total loading dose (rapid, IV) is di- vided and administered 50% of dose over 5 min, then 25% at 4-8 hr after initial dose, and last 25% at 8-16 hr after first dose Heart failure • Target serum level ≤1.3 nmol/L Optional loading dose • Adult: IV/PO 10 mcg/kg lean body weight Maintenance dose • Adult: PO 0.0625-0.125 mg daily (usual max, 0.25 daily) • Older adult: PO 0.0625-0.125 mg daily (usual max, 0.125 mg daily) Atrial fibrillation • Target serum level 1.3-2.6 nmol/L Optional loading dose • Adult: IV/PO 10 mcg/kg lean body weight Adult dosages/body weight Maintenance dose • Adult: PO 0.125-0.25 mg daily (usual max 0.25 mg daily) Child: 2-5 yr: 10-15 mcg/kg: 5-10 yr: 7-10 mcg/kg; >10 yr 3-5 mcg/kg Digitalization and maintenance doses (digoxin IV and digoxin oral solution) in children Oral IV Digi- Digi- Daily taliz- taliz- mainte- ing ing nance Dose Dose dose PO/ (mcg/ (mcg/ IV (mcg/ Clinical Age kg) kg) kg) Notes Prema- 20-30 15-25 20%-30% Divided ture of digitaliz- daily ing dose dosing Full 25-35 20-30 25%-35% Term of digitaliz- ing dose 1-24 35-60 30-50 mo 2-5 yr 30-40 25-35 5-10 yr 20-35 15-30 Over 10-15 8-12 Adult 10 yr dosages/ body weight
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SIDE EFFECTS CNS: Headache, drowsiness, apathy, con- fusion, disorientation, fatigue, depression, hallucinations CV: Dysrhythmias, hypotension, brady- cardia, AV block EENT: Blurred vision, yellow-green halos, photophobia, diplopia GI: Nausea, vomiting, anorexia, abdomi- nal pain, diarrhea
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INTERACTIONS Increase: toxicity—azole antifungals, macrolides, tetracyclines, ritonavir; moni- tor for toxicity Increase: hypercalcemia, hypomagnese- mia, digoxin toxicity—thiazides, paren- teral calcium; monitor electrolytes Increase: hypokalemia, digoxin toxicity— diuretics, amphotericin B, carbenicillin, ticarcillin, corticosteroids Increase: digoxin levels—propantheline, quiNIDine, verapamil, amiodarone, anti- cholinergics, dilTIAZem, NIFEdipine, indomethacin Increase: bradycardia—beta-adrenergic blockers, antidysrhythmics Increase: cardiac dysrhythmia risk— sympathomimetics Decrease: digoxin absorption— antacids, kaolin/pectin, cholestyramine, metoclopramide Decrease: digoxin level—thyroid agents, cholestyramine, colestipol, metoclo- pramide, aMILoride Drug/Food Decrease: digoxin effect—food, separate by ≥1 hr Decrease: GI absorption—flaxseed, psyllium Drug/Herb Increase: cardiac effects—foxglove, goldenseal, hawthorn, rue Decrease: product effect—St. John’s wort Drug/Lab Test Increase: CPK
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TREATMENT OF OVERDOSE: Discontinue product; give potassium; monitor ECG; give adrenergic-blocking agent, digoxin immune FAB
Source page 395
Extracted information for digoxin only.
Available forms: Elixir 0.05 mg/mL; tablets 0.0625, 0.125, 0.1875, 0.25, 0.5 mg; injection , 0.25 mg/mL; pediatric injection 0.1 mg/mL • Serum levels should be drawn just prior to the next scheduled dose or within 6-8 hr after last dose • Apical heart rate (BPM) must be assessed prior to administering dose; follow agency protocol for minimum BPM for administering digoxin (usu- ally 60 BPM)
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Administer: PO route • Serum levels should be drawn just prior to the next scheduled dose or again 6-8 hr after the last dose • Apical heart rate (BPM) must be assessed prior to administering dose; follow agency protocol for minimum BPM for administering digoxin (usu- ally 60 BPM) • Bioavailability varies among different oral dosage forms and different brands; changing from one preparation to another might require dosage adjustments • Digitalization may be done either by rapid digitalization with a loading dose over days or gradual digitization with slow titration over weeks • Digoxin injection is often used first to achieve rapid digitalization, then switched to PO dosing for maintenance • Total loading dose (rapid, IV) is divided and administered: 50% of dose over 5 min, then 25% at 4-8 hr after initial dose, and last 25% at 8-16 hr after first dose • All dosage forms: may be adminis- tered without regard to meals • Tablet: may be crushed and adminis- tered with food or fluids • Pediatric elixir: administer using a calibrated measuring device Injectable • When changing from PO to IM/IV, use 20%-25% less • IV is preferred over IM because it is less painful and more rapid action • PO should replace parenteral therapy as soon as possible • Visually inspect parenteral products for par- ticulate matter and discoloration prior to use IM route • Do not administer >2 mL at any one IM injection site • Inject deeply into gluteal muscle, then massage area IV route • Monitor ECG during and for 6 hr after IV use; watch for dysrhythmias or brady- cardia; notify prescriber • May be given undiluted or each 1 mL may be diluted in 4 mL of sterile water for injection, NS, D5W, or LR; diluent volumes <4 mL will cause precipitation; use diluted solutions immediately • Inject over ≥5 min via Y-site or 3-way stopcock; in patients with pulmonary edema, administer over 10-15 min; to avoid inadvertent overdosage, do not flush the syringe following administration • Check for potency and check site for redness, inflammation, infiltration; tissue sloughing can occur Y-site compatibilities: Acyclovir, alfent- anil, amikacin, aminocaproic acid, ami- nophylline, amphotericin B lipid complex, anidulafungin, ascorbic acid injection, D atenolol, atracurium, atropine, aztreo- nam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorpha- nol, calcium chloride/gluconate, CARBO- platin, ceFAZolin, cefonicid, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, cefti- zoxime, cefTRIAXone, cefuroxime, chlor- amphenicol, chlorproMAZINE, cimeti- dine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, codeine, cyanoco- balamin, cyclophosphamide, cycloSPO- RINE, cytarabine, DACTINomycin, DAPTO- mycin, dexamethasone, dexmedetomidine, diltiazem, diphenhydrAMINE, DOBUTa- mine, DOCEtaxel, DOPamine, doripenem, doxacurium, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, famoti- dine, fenoldopam, fentaNYL, fludarabine, fluorouracil, folic acid, furosemide, ganci- clovir, gatifloxacin, gemcitabine, gentami- cin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, ifosfamide, imipenem-cila statin, indomethacin, irinotecan, isoproterenol, ketorolac, labetalol, levo- floxacin, lidocaine, linezolid, LORazepam, LR, magnesium sulfate, mannitol, mech- lorethamine, meperidine, meropenem, methicillin, methotrexate, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, miconazole, midazolam, milrinone, mor- phine, multiple vitamins injection, myco- phenolate mofetil, nafcillin, nalbuphine, naloxone, nesiritide, metilmicin, nitro- glycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxali- platin, oxytocin, palonosetron, pamidro- nate, pancuronium, pantoprazole, papav- erine, PEMEtrexed, penicillin G potassium/ sodium, pentazocine, PENTobarbital, PHENobarbital, phenylephrine, phytonadi- one, piperacillin, piperacillin-tazobactam, polymyxin B, potassium chloride, pro- cainamide, prochlorperazine, prometha- zine, propranolol, protamine, pyridoxine, quiNIDine, ranitidine, remifentanil, Ring- er’s, ritodrine, riTUXimab, rocuronium, sodium acetate/bicarbonate, succinylcho- line, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcil- lin, ticarcillin-clavulanate, tigecycline, tirofiban, TNA, tobramycin, tolazoline, TPN, trastuzumab, trimetaphan, uroki- nase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, vitamin B complex, voricon- azole, zoledronic acid
Source pages 392, 393, 394
Extracted information for digoxin only.
Assess: • Apical pulse for 1 min prior to giv- ing product; if pulse <60 in adult or <90 in infant, take again in 1 hr; if <60 in adult, call prescriber; note rate, rhythm, character; monitor ECG continuously during parenteral loading dose; monitor I&O, daily weight; check for edema • Electrolytes: potassium, sodium, chlo- ride, magnesium, calcium; renal function studies: BUN, creatinine; blood studies: ALT, AST, bilirubin, Hct, Hb before initiat- ing treatment and periodically thereafter; monitor for decrease or increase in po- tassium • Monitor product levels; therapeutic level 0.5-2 ng/mL, draw ≥6-8 hr after last dose, optimally 12-24 hr after a dose • Beers: avoid dosage >0.125 mg/dL in atrial fibrillation, heart failure in older adults; decreased renal clearance may lead to toxicity • Pregnancy/breastfeeding: no well- controlled studies; use only if clearly needed; excreted in breast milk (small amounts), may breastfeed
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Evaluate: • Therapeutic response: decrease in heart failure, dysrhythmias; serum di- goxin level (0.5-2 ng/mL)
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Not to stop product abruptly; about all aspects of product; to take exactly as or- dered; how to monitor heart rate • To avoid OTC medications, herbal remedies because many adverse product interactions may occur; not to take ant- acid within 2 hr of this product • To notify prescriber of loss of appetite, lower stomach pain, diarrhea, weakness, drowsiness, headache, blurred or yellow vision, rash, depression, toxicity • About the toxic symptoms of this product; when to notify prescriber • To maintain a sodium-restricted diet as ordered • To use one brand consistently, to keep in original container • To notify prescriber if pregnancy is planned or suspected • To carry ID stating condition treated, products taken • How to take pulse, when to notify prescriber
Source page 395
Extracted information for digoxin only.
PHARMACOKINETICS Half-life 30-40 hr, excreted in urine, protein binding 20%-30% PO: Onset ½-2 hr, peak 2-6 hr, duration 3-4 days IV: Onset 5-30 min, peak 1-4 hr, dura- tion variable
Source page 394
Filter the extracted dose blocks for this individual drug.