Digoxin

Digoxin Brands

Brand Name Manufacturer Name Distributor Drug Strength Packaging Formulation Formulation Strength Price
Digoxin Arrow Generics Metro Pharmaceuticals Ltd. 0.25mg 28 Tablet per tablet KES 165.00
Digoxin Arrow Generics Metro Pharmaceuticals Ltd. 0.125mg 28 Tablet per tablet KES 165.00
Digoxin Arrow Generics Metro Pharmaceuticals Ltd. 0.0625mg 28 Tablet per tablet KES 165.00
Digoxin Arrow Generics Metro Pharmaceuticals Ltd. 50mg/12.5 mg 28 Tablet per tablet KES 103
Digoxin Arrow Generics Metro Pharmaceuticals Ltd. 50mg/12.5 mg 1000 Tablet per tablet KES 1085
Digoxin Actavis (also see Alpharma) Kulal International Ltd. 50mg/12.5 mg 1000 Tablet per tablet KES 700
Digoxin Actavis (also see Alpharma) Kulal International Ltd. 50mg/12.5 mg 40 Tablet per tablet KES 120
Digoxin Actavis (also see Alpharma) Kulal International Ltd. 50mg/12.5 mg 1000 Tablet per tablet KES 1400
Lanoxin GlaxoSmithkline GlaxoSmithKline 50mg/12.5 mg 500 KES 4,759.20
Lanoxin GlaxoSmithkline GlaxoSmithKline 50mg/12.5 mg 60ml spray KES 1,941
Lanoxin GlaxoSmithkline GlaxoSmithKline 50mg/12.5 mg 5 Injection per ml KES 1,499.10
Digitalis Prism Life Sciences Galaxy Pharmaceuticals Ltd 0.25mg 100 Tablet per tablet KES 225.00

Digoxin More info

Mode Of Action

Cardiac glycosides increase intracellular calcium and allows more calcium to enter the myocardial cell during depolarization via a sodium-potassium pump mechanism. This increases force of contraction, increases renal perfusion, decreases heart rate and decreases AV node conduction velocity.
Drug Indication Congestive heart failure, atrial flutter, paroxysmal atrial tachycardia, cardiogenic shock.
Precautions Thyroid disease, sick sinus syndrome, elderly, renal impairment/hypokaleamia, pregnancy, rapid I.V administration, psychotropic drugs, large oral calcium doses, coronary insufficiency.
Contra-Indications Ventricular fibrillation, ventricular tachycardia, beriberi heart diseases, allergy to cardiac glycosides, second-degree AV block, intermittent complete heart block.
Side Effects Most common: anorexia, nausea and vomiting. Others: cardiac arrhythmias, CNS disturbances, visual disturbances and gynaecomastia.
Dosage When symptoms are mild, slow digitalization is safer and just as effective as the rapid method. If symptoms are moderately severe, the rapid oral method may be used, but the patient should be examined before each dose with particular attention to the cardiac rhythm. An ECG should be recorded if there is any doubt about the nature of the pre-therapy rhythm or changes during digitalization. Intravenous digitalization is rarely required in chronic heart failure; it should be used only in hospitalized patients with careful monitoring. Adults: Rapid digitalization orally: 0.75mg to 1.5mg as single dose followed by maintenance dose. Slow digitalization orally: 0.25-0.75mg daily for about one week, followed by maintenance dose. Maintenance dose: 0.25-0.5mg daily. Children under 10 years: Digitalization; 10-20mcg/kg 6 hourly. Maintenance; 10-20mcg/kg in a single or divided dose. Emergency digitalization; 0.5-1.0mg given by total parental dose slowly
Pregnancy Category Category A1:
Pregnancy Category Description Drugs which have been taken by a sizeable number of pregnant women and women of child-bearing age with no any established rise in the frequency of malformations or other direct or indirect detrimental effects on the foetus having been noted.

osing: Adult

Note: When changing from oral (tablets or liquid) or I.M. to I.V. therapy, dosage should be reduced by 20% to 25%.

Atrial fibrillation (rate control) in patients with heart failure: Loading dose: I.V.: 0.25 mg every 2 hours, up to 1.5 mg within 24 hours; for nonacute situations, may administer 0.5 mg orally once daily for 2 days followed by oral maintenance dose. Maintenance dose: I.V., Oral: 0.125-0.375 mg once daily (Fuster, 2006)

Heart failure: Daily maintenance dose (Note: Loading dose not recommended): Oral: 0.125-0.25 mg once daily; higher daily doses (up to 0.5 mg/day) are rarely necessary. If patient is >70 years of age, has impaired renal function, or has a low lean body mass, low doses (eg, 0.125 mg daily or every other day) should be used (Hunt, 2009).

Supraventricular tachyarrhythmias (rate control):

Initial: Total digitalizing dose:

Oral: 0.75-1.5 mg

I.V., I.M.: 0.5-1 mg (Note: I.M. not preferred due to severe injection site pain.)

Give 1/2 (one-half) of the total digitalizing dose (TDD) as the initial dose, then give 1/4 (one-quarter) of the TDD in each of 2 subsequent doses at 6- to 8-hour intervals. Obtain ECG 6 hours after each dose to assess potential toxicity.

Daily maintenance dose:

Oral: 0.125-0.5 mg once daily

I.V., I.M.: 0.1-0.4 mg once daily (Note: I.M. not preferred due to severe injection site pain.)

Dosing: Pediatric

Atrial dysrhythmias (rate control), HF: When changing from oral (tablets or liquid) or I.M. to I.V. therapy, dosage should be reduced by 20% to 25%. See table.

Dosage Recommendations for Digoxin1

Age

Total Digitalizing Dose2,3

(mcg/kg)

Daily Maintenance Dose3,4

(mcg/kg)

Oral

I.V. or I.M.5

Oral

I.V. or I.M.5

1 Heart failure: A lower serum digoxin concentration may be adequate to treat heart failure (compared to cardiac arrhythmias); consider doses at the lower end of the recommended range for treatment of heart failure; a digitalizing dose (loading dose) may not be necessary when treating heart failure (Ross, 2001).

2 Do not give full total digitalizing dose (TDD) at once. Give one-half of the total digitalizing dose (TDD) in the initial dose, then give one-quarter of the TDD in each of two subsequent doses at 6- to 8-hour intervals. Obtain ECG 6 hours after each dose to assess potential toxicity.

3Based on lean body weight and normal renal function for age. Decrease dose in patients with decreased renal function; digitalizing dose often not recommended in infants and children.

4Divided every 12 hours in infants and children <10 years of age. Given once daily to children >10 years of age and adults.

5I.M. not preferred due to severe injection site pain. If I.M. route is necessary, administer as deep injection followed by massage of injection site.

Preterm infant

20-30

15-25

5-7.5

4-6

Full-term infant

25-35

20-30

6-10

5-8

1 mo - 2 y

35-60

30-50

10-15

7.5-12

2-5 y

30-40

25-35

7.5-10

6-9

5-10 y

20-35

15-30

5-10

4-8

>10 y

10-15

8-12

2.5-5

2-3

Adverse Reactions Significant

Incidence not always reported.

Cardiovascular: Accelerated junctional rhythm, asystole, atrial tachycardia with or without block, AV dissociation, first-, second- (Wenckebach), or third-degree heart block, facial edema, PR prolongation, PVCs (especially bigeminy or trigeminy), ST segment depression, ventricular tachycardia or ventricular fibrillation

Central nervous system: Dizziness (6%), mental disturbances (5%), headache (4%), apathy, anxiety, confusion, delirium, depression, fever, hallucinations

Dermatologic: Rash (erythematous, maculopapular [most common], papular, scarlatiniform, vesicular or bullous), pruritus, urticaria, angioneurotic edema

Gastrointestinal: Nausea (4%), vomiting (2%), diarrhea (4%), abdominal pain, anorexia

Neuromuscular & skeletal: Weakness

Ocular: Visual disturbances (blurred or yellow vision)

Respiratory: Laryngeal edema

<1% (Limited to important or life-threatening): Asymmetric chorea, gynecomastia, thrombocytopenia, palpitation, intestinal ischemia, hemorrhagic necrosis of the intestines, vaginal cornification, eosinophilia, sexual dysfunction, diaphoresis

Children are more likely to experience cardiac arrhythmia as a sign of excessive dosing. The most common are conduction disturbances or tachyarrhythmia (atrial tachycardia with or without block) and junctional tachycardia. Ventricular tachyarrhythmias are less common. In infants, sinus bradycardia may be a sign of digoxin toxicity. Any arrhythmia seen in a child on digoxin should be considered as digoxin toxicity. The gastrointestinal and central nervous system symptoms are not frequently seen in children.