Drug Action
Digoxin is a cardiac glycoside that increases the force of myocardial contraction and reduces conductivity within the atrioventricular (AV) node.
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Individual generic drug information
Extracted information for Digoxin only.
Digoxin is a cardiac glycoside that increases the force of myocardial contraction and reduces conductivity within the atrioventricular (AV) node.
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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 ▶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
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DUE TO INTERACTIONS ▶Manufacturer advises reduce dose by half with concurrent use of amiodarone, dronedarone and quinine. 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. l UNLICENSED USE Digoxin doses in the BNF may differ from those in product literature.
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Constrictive pericarditis (unless to control atrial fibrillation or improve systolic dysfunction— but use with caution). hypertrophic cardiomyopathy (unless concomitant atrial fibrillation and heart failure— but use with caution). intermittent complete heart block. myocarditis. second degree AV block. supraventricular arrhythmias associated with accessory conducting pathways e.g. Wolff-Parkinson-White syndrome (although can be used in infancy). ventricular tachycardia or fibrillation
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Hypercalcaemia (risk of digitalis toxicity). hypokalaemia (risk of digitalis toxicity). hypomagnesaemia (risk of digitalis toxicity). hypoxia (risk of digitalis toxicity). recent myocardial infarction. severe respiratory disease. sick sinus syndrome. thyroid disease CAUTIONS, FURTHER INFORMATION ▶Elderly Prescription potentially inappropriate (STOPP criteria): . in heart failure with normal systolic ventricular function (no clear evidence of benefit) . at a long-term dose greater than 125 micrograms daily if eGFR less than 30 mL/minute/1.73 m2 (risk of digoxin toxicity if plasma levels not measured) See also Prescribing in the elderly p. 33.
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Extracted information for Digoxin only.
→Appendix 1: digoxin
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▶Common or very common Arrhythmias. cardiac conduction disorder. cerebral impairment. diarrhoea. dizziness. eosinophilia. nausea. skin reactions. vision disorders. vomiting ▶Uncommon Depression ▶Rare or very rare Appetite decreased. asthenia. confusion . gastrointestinal disorders. gynaecomastia. headache. malaise. psychosis. thrombocytopenia Overdose If toxicity occurs, digoxin should be withdrawn; serious manifestations require urgent specialist management.
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Dose adjustments May need dosage adjustment.
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Amount too small to be harmful.
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Dose adjustments Reduce dose. Monitoring Monitor plasma-digoxin concentration in renal impairment.
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▶For plasma-digoxin concentration assay, blood should be taken at least 6 hours after a dose. ▶Monitor serum electrolytes and renal function. Toxicity increased by electrolyte disturbances.
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Extracted information for Digoxin only.
▶With intravenous use Avoid rapid intravenous administration (risk of hypertension and reduced coronary flow). For intravenous infusion (Lanoxin ®), give intermittently in Glucose 5% or Sodium chloride 0.9%; dilute to a concentration of not more than 62.5 micrograms/mL. To be given over at least 2 hours. ▶With oral use For oral administration, oral solution must not be diluted.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution, solution for injection Tablet ▶Digoxin (Non-proprietary) Digoxin 62.5 microgram Digoxin 62.5microgram tablets | 28 tablet P £9.99 DT = £1.52 Digoxin 125 microgram Digoxin 125microgram tablets | 28 tablet P £4.99 DT = £1.52 Digoxin 250 microgram Digoxin 250microgram tablets | 28 tablet P £4.99 DT = £1.55 ▶Lanoxin (Aspen Pharma Trading Ltd) Digoxin 62.5 microgram Lanoxin PG 62.5microgram tablets | 500 tablet P £8.09 Digoxin 125 microgram Lanoxin 125 tablets | 500 tablet P £8.09 Digoxin 250 microgram Lanoxin 250microgram tablets | 500 tablet P £8.09 Solution for infusion ▶Digoxin (Non-proprietary) Digoxin 250 microgram per 1 ml Digoxin 500micrograms/2ml Cardiovascular system solution for infusion ampoules | 10 ampoule P £7.00 ▶Lanoxin (Aspen Pharma Trading Ltd) Digoxin 250 microgram per 1 ml Lanoxin 500micrograms/2ml solution for infusion ampoules | 5 ampoule P £3.30 Oral solution ▶Lanoxin (Aspen Pharma Trading Ltd) Digoxin 50 microgram per 1 ml Lanoxin PG 50micrograms/ml elixir | 60 ml P £5.35 DT = £5.35 Bleeding disorders Antifibrinolytic drugs and haemostatics Overview Fibrin dissolution can be impaired by the administration of tranexamic acid below, which inhibits fibrinolysis. It can be used to prevent bleeding or to treat bleeding associated with excessive fibrinolysis (e.g. in surgery, dental extraction, obstetric disorders, and traumatic hyphaema) and in the management of menorrhagia. Tranexamic acid may also be used in hereditary angioedema, epistaxis, and in thrombolytic overdose. Desmopressin p. 704 is used in the management of mild to moderate haemophilia and von Willebrand’s disease. It is also used for fibrinolytic response testing. Etamsylate reduces capillary bleeding in the presence of a normal number of platelets; it does not act by fibrin stabilisation, but probably by correcting abnormal adhesion. Etamsylate is less effective than other treatments in the management of heavy menstrual bleeding and its use is no longer recommended. ANTIHAEMORRHAGICS › ANTIFIBRINOLYTICS
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Extracted information for Digoxin only.
Patient counselling is advised for digoxin elixir (use pipette).
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Filter the extracted dose blocks for this individual drug.
First line only; read the complete Indications and dose section above.
0.75–1.5 mg in divided doses, dose to be given
This is a first-line fragment. Read the full Indications and Dose section above.
Candidate age grouping · source page 138
First line only; read the complete Indications and dose section above.
Maintenance 125–250 micrograms daily, dose
This is a first-line fragment. Read the full Indications and Dose section above.
Candidate age grouping · source page 138
First line only; read the complete Indications and dose section above.
62.5–125 micrograms once daily, reduce dose in
This is a first-line fragment. Read the full Indications and Dose section above.
Candidate age grouping · source page 138
First line only; read the complete Indications and dose section above.
Loading dose 0.75–1 mg, to be given over at
This is a first-line fragment. Read the full Indications and Dose section above.
Candidate age grouping · source page 138