Digoxin notes by S.
Dirivien
Brand Name: Lanoxin
Generic Name: Digoxin
Drug Class: Antidysrhythmics, V; Inotropic Agents
WHAT IS DIGOXIN AND HOW DOES IT WORK?
Digoxin is used to treat heart failure, usually along with other medications. It is
also used to treat a certain type of irregular heartbeat (chronic atrial
fibrillation). Treating heart failure may help maintain your ability to walk and
exercise and may improve the strength of your heart. Treating an irregular
heartbeat can decrease the risk for blood clots, an effect that may reduce your
risk for a heart attack or stroke.
Digoxin belongs to a class of medications called cardiac glycosides. It works
by affecting certain minerals (sodium and potassium) inside heart cells. This
reduces strain on the heart and helps it maintain a normal, steady, and strong
heartbeat.
Digoxin is available under the following different brand names: Lanoxin.
Dosage of Digoxin:
Adult and Pediatric Dosage Forms and Strengths
Oral solution
0.05 mg/mL
Injectable solution
0.1 mg/mL
0.25 mg/mL
Tablet
0.0625 mg (Lanoxin only) (adult only)
0.125 mg
0.1875 mg (Lanoxin only) (adult only)
0.25 mg
Atrial Fibrillation
Rapid digitalizing (loading-dose) regimen
Intravenous (IV): 8-12 mcg/kg (0.008-0.012 mg/kg) total loading dose;
administer 50% initially; then may cautiously give 1/4 the loading dose every
6-8 hours twice; perform careful assessment of clinical response
and toxicity before each dose
Oral: 10-15 mcg/kg total loading dose; administer 50% initially; then
may cautiously give 1/4 the loading dose every 6-8 hours twice; perform
careful assessment of clinical response and toxicity before each dose
Maintenance
Oral: 3.4-5.1 mcg/kg/day or 0.125-0.5 mg/day orally; may increase dose
every 2 weeks based on clinical response, serum drug levels, and toxicity
Intravenous/intramuscular (IV/IM): 0.1-0.4 mg once/day; IM route not
preferred due to severe injection site reaction
Heart Failure
As per ACCF/AHA guidelines, a loading dose to initiate
digoxin therapy in patients with heart failure is not necessary
0.125-0.25 mg orally/IV once/day; higher doses including 0.375-0.5
mg/day rarely needed
Use lower end of dosing (0.125 mg/day) in patients with
impaired renal function or low lean body mass
Heart Failure/Atrial Fibrillation, Pediatric
Use doses at the lower end of the spectrum when treating heart failure
Reduce dose by 20-25% when changing from oral formulation or
intramuscular (IM) to intravenous (IV) therapy
Premature neonate
o Oral: 1st loading dose, 10-15 mcg/kg; 2nd and 3rd loading doses,
5-7.5 mcg/kg every 6-8 hours for 2 doses; maintenance: 5-7.5 mcg/kg/day
divided every 12 hours
o Intravenous/intramuscular (IV/IM): 1st loading dose, 7.5-12.5
mcg/kg; 2nd and 3rd loading doses, 3.75-6.25 mcg/kg every 6-8 hours for 2
doses; maintenance: 4-6 mcg/kg/day divided every 12 hours
Full-term neonate
o Oral: 1st loading dose, 12.5-17.5 mcg/kg; 2nd and 3rd loading
doses, 6.25-8.75 mcg/kg every 6-8 hours for 2 doses; maintenance: 6-10
mcg/kg/day divided every 12 hours
o IV/IM: 1st loading dose, 10-15 mcg/kg; 2nd and 3rd loading
doses, 5-7.5 mcg/kg every 6-8 hours for 2 doses; maintenance: 5-8
mcg/kg/day divided every 12 hours
Infants and children 1-24 months
o Oral: 1st loading dose, 17.5-30 mcg/kg; 2nd and 3rd loading
doses, 8.75-15 mcg/kg every 6-8 hours for 2 doses; maintenance: 10-15
mcg/kg/day divided every 12 hours
o IV/IM: 1st loading dose, 15-25 mcg/kg; 2nd and 3rd loading
doses, 7.5-12.5 mcg/kg every 6-8 hours for 2 doses; maintenance: 7.5-12
mcg/kg/day divided every 12 hours
2-5 years
o Oral: 1st loading dose, 15-20 mcg/kg; 2nd and 3rd loading doses,
8.75-10 mcg/kg every 6-8 hours for 2 doses; maintenance: 7.5-10 mcg/kg/day
divided every 12 hours
o IV/IM: 1st loading dose, 12.5-17.5 mcg/kg; 2nd and 3rd loading
doses, 6.25-8.75 mcg/kg every 6-8 hours for 2 doses; maintenance: 6-9
mcg/kg/day divided every 12 hours
5-10 years
o Oral: 1st loading dose, 10-17.5 mcg/kg; 2nd and 3rd loading
doses, 5-8.75 mcg/kg every 6-8 hours for 2 doses; maintenance: 5-10
mcg/kg/day divided every 12 hours
o IV/IM: 1st loading dose, 7.5-15 mcg/kg; 2nd and 3rd loading
doses, 3.75-7.5 mcg/kg every 6-8 hours for 2 doses; maintenance: 4-8
mcg/kg/day divided every 12 hours
Older than 10 years and less than 100 kg
o Oral: 1st loading dose, 5-7.5 mcg/kg; 2nd and 3rd loading doses,
2.5-3.75 mcg/kg every 6-8 hours for 2 doses; maintenance: 2.5-5 mcg/kg/day
o IV/IM: 1st loading dose, 4-6 mcg/kg; 2nd and 3rd loading doses,
2-3 mcg/kg every 6-8 hours for 2 doses; maintenance: 2-3 mcg/kg/day
Dosing Modifications
Adjust maintenance dose by estimating renal clearance and measuring
serum levels
In heart failure, higher dosages have no additional benefit and may
increase toxicity; decreased renal clearance may lead to increased toxicity
In geriatric patients, use lean body weight to calculate dose
