Composition
Tab 125 mcg/250 mcg: Digoxin 125 mcg/250 mcg. PG Tab 62.5 mcg: Digoxin 62.5 mcg. lnj: Per 2 ml: Digoxin 500 mcg (250 mcg/ ml). Liqd: Per ml: Digoxin 50 mcg.
Indications & Dosage
Rapid digitalisation, for atrial fibrillation or flutter: ORAL: 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; 125-250 mcg daily, dose according to renal function and initial loading dose, reduce dose in the elderly. Heart failure (for patients in sinus rhythm): ORAL: Adult: 62.5-125 mcg once daily, reduce dose in the elderly. Emergency loading dose, for atrial fibrillation or flutter: BY IV INF: 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. 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. Childrens Digitalizing Dose: Premature Infants: 20-30 mcg/kg orally or 15-25 mcg/kg IV. Full-Term Infants: 25-35 mcg/kg orally or 20-30 mcg/kg IV. 1-24 months: 35-60 mcg/kg orally or 30-50 mcg/kg IV 2-5 yrs age: 30-40 mcg/kg orally or 25-35 mcg/kg IV 5-10 yrs age: 20-35 mcg/kg orally or 15-30 mcg/kg N. Above 10 yrs age: 10-15 mcg/kg orally or 8-12 mcg/kg IV. Maintenance: Premature Infants: 20-30% of digitalizing dose. Full- Term Infants to more than 10 yrs age: 25-35% of digitalizing dose. 2-5 yrs age: 10-15 mcg/kg orally. 5-10 yrs age: 7-10 mcg/kg orally. Above 10 yrs age: 3-5 mcg/kg.
Administration
Administer by direct IV inj slowly over a period of 5 min or longer, given undiluted or diluted with a fourfold or greater volume of SWFI, D5W or NS.
Compatibility
Stable in D5 1/2 NS, with KCI 20 mEq, D5W, D1OW, LR, 1/2NS, NS and SWFI (when diluted fourfold or greater). .
Stability
Store at 25C (77F); excursions are permitted be-tween 15C -30C (59F-86F). Protect from light.
Contraindications
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 Wolff-Parkinson-White syndrome, ventricular tachycardia or fibrillation
Precautions
Constrictive pericarditis, recent infarction, sick sinus syndrome, thyroid disease, reduce dose in the elderly and in renal impairment, hypomagnesaemia, hypercalcaemia, hypokalaemia and hypoxia (risk of digitalis toxicity) avoid rapid intravenous administration (nausea and risk of arrhythmias).
Interactions
Diuretics, lithium, corticosteroids, carbenoxolone, lithium, other K+ depleting agents, alprazolam, ami-odarone, gentamicin, indomethacin, itraconazole, captopril, verapamil, felodipine, tiapamil, flecainide, prazosin, propafenone, quinidine, quinine, beta-blockers, suxamethonium, spironolactone, tetracycline, erythromycin, trimethoprim, propantheline, adrenaline, antacids, kaolin, pectin, laxatives, cholestyramine, acarbose, salbutamol, diphenoxylate, sulphasalazine, neomycin, rifampicin, cytostatics, phenytoin, metoclopramide, penicillamine, calcium inj or supplement, other cardiac glycosides, St. Johns Wort.
Pregnancy
Caution advised, risk cannot be ruled out.
Lactation
Caution advised.
Side Effects
Arrhythmias, blurred vision, conduction disturbances, diarrhoea, dizziness, eosinophilia, nausea, rash, vomiting, depression. Rare: Anorexia, apathy, confusion, fatigue, gynaecomastia (on long-term use),headache, intestinal ischaemia and necrosis, psychosis, thrombocytopenia, weakness, toxicity with overdose.