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Last Updated on February 19, 2017 by Dr.Derek Fhisher

Most popular brand: Lanoxin
Active ingredient: Digoxin
Available dosage forms: 0,25 mg

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Digoxin (Digoxin): instruction, and the use of a formula

The nosological classification (ICD – 10)

Code CAS

Feature substance Digoxin

digitalis glycoside woolly leaves. The white crystalline powder. It is soluble in water, practically insoluble in alcohol.

Pharmacology

Mode of action – cardio, antiarrhythmic.

It has a positive inotropic, negative chrono – and dromotropic positive batmotroponoe (in toxic doses). Inhibits of Na + – K + – ATPase membrane of cardiomyocytes, increases intracellular sodium concentration and mediated ; calcium. Calcium ions interact with the troponin complex, eliminate its inhibitory effect on the contractile protein complex. Well absorbed by ingestion (65 – 80%). T _1/2 is 34 –. 51 hours evenly distributed to organs and tissues. Some is released into the duodenum to the bile and undergoes reabsorption. Able to cumulate (to a lesser extent than digitoxin). Associated with the plasma protein by 35 – 40%. Excreted primarily in the urine (pregnancy ; too slowly). In patients with chronic heart failure is mediated vasodilation mildly increases urine output (mainly due to improved hemodynamics). Once inside cardiotonic effect develops in 1 – 2 hours, reaches a maximum for 8 hours, after the on / in ; 20 – 30 min. In patients with undamaged liver and kidney function is terminated after 2 – 7 days. In myocardial sensitivity to digoxin (and other glycosides) affects plasma electrolytes (low levels of K + and Mg 2+. Increase in Ca 2+ and Na + increases the sensitivity).

Application of the substance Digoxin

Chronic heart failure, atrial tachyarrhythmia, supraventricular paroxysmal tachycardia, atrial flutter.

Contraindications

Hypersensitivity glycoside intoxication, WPW – syndrome. AV blockade II – III Art. (If you do not set an artificial pacemaker), intermittent complete blockade.

Restrictions on the use

AV blockade degree I, the likelihood of unstable AV node, attacks Morgagni – Adams – Stokes history, hypertrophic obstructive cardiomyopathy, isolated mitral stenosis with a low heart rate. cardiac asthma with mitral stenosis (in the absence of tahisistolicheskoy atrial fibrillation), acute myocardial infarction, unstable angina, arteriovenous shunt, hypoxia, heart failure with diastolic dysfunction (restrictive cardiomyopathy, amyloidosis heart, constrictive pericarditis, cardiac tamponade), arrythmia, marked dilatation the cavities of the heart, pulmonary heart, electrolyte disorders (hypokalemia, hypomagnesemia, hypercalcemia, hypernatremia), hypothyroidism, alkalosis, myocarditis, renal / hepatic insufficiency, obesity, advanced age.

Application of pregnancy and breastfeeding

Category effects on the fetus by FDA ; C.

Side effects of substance Digoxin

From the nervous system and sensory organs: headache, dizziness, sleep disturbance, drowsiness, weakness, confusion, delirium, hallucinations, depression; possible violation of color vision, decreased visual acuity, scotoma, macro – and micropsia.

From the digestive tract: nausea, vomiting, anorexia, diarrhea, abdominal pain.

From the cardio – vascular system and blood (blood, hemostasis): bradycardia, ventricular premature beats, AV block, thrombocytopenia, thrombocytopenic purpura, epistaxis, petechiae.

Other: gynecomastia during prolonged use, bowel ischemia, rash.

Interaction

Adrenomimetiki increase the chance of developing an arrhythmia; antiarrhythmic drugs, and anticholinesterase – bradycardia; glucocorticoids, saluretiki and other means to support the loss of potassium, calcium supplementation ; glycoside intoxication. Chlorpromazine reduces cardiotonic effect; laxatives, antacids, agents containing aluminum, bismuth, magnesium, ; suction. Rifampicin accelerates metabolism.

Overdose

Symptoms: AV blockade, vomiting, nausea, arrhythmia.

Treatment: potassium supplements, dimercaprol, EDTA.

Dosing and Administration

Inside, intravenously (bolus or infusion). As for all cardiac glycosides, the dose should be chosen with care for each patient individually. If the patient before prescribing digoxin taking cardiac glycosides, it is necessary to reduce the dose of the drug. digoxin dose depends on the need for rapid therapeutic effect.

Fast digitalization (24 – 36 hours) is used in cases of emergency; daily dose of ; 0,75 – 1,25 mg ; divided into 2 – 3 doses (every 6 – 8 h). When saturation is achieved switching to maintenance therapy. Slow digitalization (5 – 7 days); daily dose of 0,125 – 0,5 g is assigned 1 times a day for 5 – 7 days (until saturation is achieved), then move on to maintenance treatment. Maintenance therapy: daily dosage for maintenance therapy is determined individually and is 0,125 – 0,75 mg. Supportive therapy is usually long. B / ; at a dose of 0,25 – 0,5 g.

Doses for children are calculated based on body weight. If the kidney function dose should be reduced according to creatinine clearance.

Trading names of drugs with working substance