DIGOXIN

 

DIGOXIN

Chemical Class: digitablis glycoside

Therapeutic Class: Antiarrhythmic; cardiac glycoside

 

BRAND NAMES	MANUFACTURER	DOSES FORM	GENERIC
Digox	Platinum	Tab 250mg	Digoxin
Digoxin	Global pharma	Tab 250mg	Digoxin
Doxin	Xenon	Syp	Digoxin
Lanoxin	Glaxo sminthkline	Tab 250mg,inj 0.5mg 2ml	Digoxin
Maxin	Mac & Rains	Syp 0.005%  60ml	Digoxin

INDICATIONS:

Congestive cardiac failure, cardiac dysarrhythmias, paroxysmal supraventricular tachycardia (particularly atrial fibrillation). CONTRAINDICATIONS: Ventricular tachycardia, ventricular fibrillation.

DOSE: Adult

Rapid digitalisation by mouth 1-1.5mg in divided doses over 24 hours; less urgent degitalisation, 250 500 micrograms daily ( higher doses may be divided, maintainance by mouth 62-5-500 microgram daily Higher doses may be divided) according to renal function and in atrial fibrilation, on heart rate response; usual range 125-250mg daily (Lower dose may be appropriate in elderly)

Inj:* Emergency Loading dose by intravenous infusion (but rarely nevessary) 0.75-1mg over at least 2 hours than maintainance dose by mouth on the following day.

Children: 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 years age. 30-40 mcg/kg orally or 25-35 mcg/kg IV. 5-10 years age: 20-35 mcg/kg orally or 15-30 mcg/kg I.V. above 10 years 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 years age: 25-35% of digitalizing dose. 2 5 years age: 10-15 mcg/kg orally. 5-10 years age: 7-10 mcg/kg orally. Above 10 years 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 of greater volume of SWFI, D5W or NS. PRECAUTIONS: Hypokalemia, hypomagnesernia, hypercalcemia, hypothyroidism, severe pulmonary disease, sick sinus syndrome, hepatic disease, acute MI, AV block, elderly, Wolff-Parkinson White syndrome Pregnancy, breast-feeding & old age:

Use with caution.

SIDE EFFECTS:

CNS: Anorexia, apathy, confusion, delirium, disorientation, drowsiness, EEG abnormalities, hallucinations, headache, mental depression, neuralgia, psychosis, restlessness, seizures, weakness

CV: Atrial fibrillation, AV block, bradycardia, premature ventricular contractions (PVCs), ventricular fibrillation, ventricular tachycardia

EENT: Visual disturbances (blurred, yellow or green vision, halo effect)

GI: Abdominal discomfort, diarrhea, hemorrhagic

necrosis of the intestines, nausea, vomiting HEME: Eosinophilia, thrombocytopenia

SKIN: Rash

INTERACTIONS

Drugs

Alprazolam, amiodarane, diltiazem, verapamil, bepri-dil, nitrendipine, quinidine, carvedilol, cyclosporine, erythromycin and tetracyclines (change in bacterial flora causing effect may persist for months), hydroxy-chloroquine, NSALDs, azole antifungals, omepra-zole, lansoprazole,  propafenone, quinine, spironolactone, tacrolimus: Increased digoxin levels  Amphotericin B diuretics: Enhanced digitalis toxicity secondary to drug-induced hypokalemia Beta-blockers: Potentiation of bradycardia Calcium (IV): Digitalis toxicity Ch-arcoal: Reduced digitalis Levels Cholestyramine, Kaolo-pectin (digoxin tablets only) neomycin, penicillamine, rifampin, sulfasalazine: Reduced digitalis levels

Cyclophosphamide:Impaired digaxin (especially tablets) absorption; digitoxin not affected Metoclopromide, cisapride: Reduced digitalis levels by slowly dissolving digoxin tablets only (Lanoxin tablets and capsules not affected)