Generic Name: Digoxin
Brand Name/s: Apo-Digoxin, Digitek, Digox, Lanoxin, Lanoxicaps
and Lanoxin Pediatric.
Drug Classification:
PHARMACOTHERAPEUTIC: Cardiac glycoside.
CLINICAL: Antiarrhythmic, cardiotonic.
Mode of Action:
Increases the force and velocity of myocardial contraction, resulting in
positive inotropic effects. Digoxin produces antiarrhythmic effects by decreasing
the conduction rate and increasing the effective refractory period of the AV node.
Dose and Route
PO: ADULTS, ELDERLY: 0.75–1.5 mg. CHILDREN 10 YRS AND OLDER: 10–15
mcg/kg. CHILDREN 5–9 YRS: 20–35 mcg/kg. CHILDREN 2–4 YRS: 30–40
mcg/kg. CHILDREN 1–23 MOS: 35–60 mcg/kg. NEONATE, FULL-TERM: 25–35
mcg/kg. NEONATE, PREMATURE: 20–30 mcg/kg.
IV: ADULTS, ELDERLY: 0.5–1 mg. CHILDREN 10 YRS AND OLDER: 8–12
mcg/kg. CHILDREN 5–9 YRS: 15–30 mcg/kg. CHILDREN 2–4 YRS: 25–35
mcg/kg. CHILDREN 1–23 MOS: 30–50 mcg/kg. NEONATES, FULLTERM: 20–30
mcg/kg. NEONATES, PREMATURE: 15–25 mcg/kg.
Heart Failure
PO: ADULTS, ELDERLY: 0.125–0.25 mg once daily.
Supraventricular Arrhythmias
PO: ADULTS, ELDERLY: Digitalizing dose: 0.125–1.5 mg. Maintenance dose:
0.125–0.5 mg once daily. IV: Digitalizing dose: 0.5–1 mg. Maintenance dose:
0.1–0.4 mg once daily.
Dosage in Renal Impairment
Dosage adjustment is based on creatinine clearance. Loading dose: Decrease by
50% in end-stage renal disease.
Indication/s:
To treat heart failure, atrial flutter, atrial fibrillation, and paroxysmal atrial
tachycardia with rapid digitalization.
Contraindications:
Hypersensitive carotid sinus syndrome, hypersensitivity to digoxin,
presence or history of digitalis toxicity or idiosyncratic reaction to digoxin,
ventricular fibrillation, and ventricular tachycardia unless heart failure occurs
unrelated to digoxin therapy.
Side Effects:
Dizziness, headache, diarrhea, rash, visual disturbances.
Adverse Effects:
The most common early manifestations of digoxin toxicity are GI
disturbances (anorexia, nausea, vomiting), neurologic abnormalities (fatigue,
headache, depression, weakness, drowsiness, confusion, nightmares). Facial
pain, personality change, ocular disturbances (photophobia, light flashes, halos
around bright objects, yellow or green color perception) may occur. Sinus
bradycardia, AV block, ventricular arrhythmias noted.
Interactions:
DRUG: Amiodarone may increase concentration/toxicity. Beta blockers (e.g.,
metoprolol), calcium channel blockers (e.g., diltiaZEM) may have additive effect
on slowing AV nodal conduction. Potassium-depleting diuretics (e.g., furosemide)
may increase toxicity due to hypokalemia. Sympathomimetics (e.g.,
norepinephrine) may increase risk of arrhythmias. HERBAL: Ephedra may
increase risk of arrhythmias. Licorice may cause sodium and water retention, loss
of potassium. FOOD: Meals with increased fiber (bran) or high in pectin may
decrease absorption. LAB VALUES: None known.
Nursing Responsibilities:
1. Before giving each dose, take patient’s apical pulse and notify prescriber if
it’s below 60 beats/minute (or other specified level).
2. Monitor patient closely for signs of digitalis toxicity, such as altered mental
status, arrhythmias, heart block, nausea, vision disturbances, and
vomiting.
3. Emphasize importance of taking digoxin exactly as prescribed. Warn about
possible toxicity from taking too much and decreased effectiveness from
taking too little.
4. Instruct patient to take digoxin at same time each day to help increase
compliance.
5. Teach patient how to take her pulse, and instruct her to do so before each
dose. Urge her to notify prescriber if pulse falls below 60 beats/minute or
suddenly increases.
6. Inform patient that small, white 0.25-mg tablets can easily be confused
with other drugs. Caution against carrying digoxin in anything other than its
original labeled container
7. Emphasize need to use special dropper supplied with elixir to ensure
accurate dose measurement.
8. Advise patient to consult prescriber before using other drugs, including
OTC products.
