As per ACCF/AHA guidelines, a loading dose to initiate digoxin therapy in patients with heart failure is not necessary0.125-0.25 mg PO/IV qDay; higher doses including 0.375-0.5 mg/day rarely neededUse lower end of dosing (0.125 mg/day) in patients with impaired renal function or low lean body massAdjust maintenance dose by estimating CrCl and measuring serum levelsIn heart failure, higher dosages have no additional benefit and may increase toxicity; decreased renal clearance may lead to increased toxicityIn geriatric patients, use lean body weight to calculate doseUse doses at the lower end of the spectrm when treating heart failureReduce dose by 20-25% when changing from oral formulation or IM to IV therapyUse caution in chronic constrictive pericarditis, electrical cardioversion, severe bradycardia, severe heart failure, severe pulmonary disease, sick sinus syndrome, ventricular tachycardia, ventricular premature contractions, Wolff-Parkinson-White syndrome, electrolyte imbalance, hypothyroidism or hyperthyroidism, hypoxia, idiopathic hypertrophic subaortic stenosis, renal disease, concomitant diureticsNot recommended in patients with acute myocardial infarctionRisk of advanced or complete heart block in patients with sinus node disease and AV blockVery narrow margin between effective therapeutic and toxic dosages: Therapeutic range, 0.5-2 ng/mL (target 0.5-1 ng/mL); toxic range, >2.5 ng/mL Generally avoid if left ventricular systolic function preserved, although may be used for ventricular rate control in subgroup with chronic atrial fibrillationLess effective in presence of hypokalemia or hypocalcemia; avoid hypercalcemia or hypomagnesemia, which may predispose to serious arrhythmiasHeart failure patients with preserved ventricular function, including acute cor pulmonale, amyloid heart disease, and constrictive pericarditis may be susceptible to digoxin toxicityMay cause false-positive ST-T changes during exercise testingDo not switch between different PO forms or between brand and generic forms of digoxin; bioavailability variesSerum levels drawn within 6-8 hours of dose will be falsely high because of prolonged distribution phaseIncreased risk of estrogen-like effects in geriatric patientsBeriberi heart disease may not respond adequately if underlying thiamine deficiency not correctedAtrial arrhythmias are difficult to treat if associated with hypermetabolic (hyperthyroidism) or hyperdynamic (hypoxia) states; treat underlying condition before initiating therapyAvoid extravasation; ensure proper needle or catheter placement prior to and during administrationMonitor for proarrhythmic effects, especially with digoxin toxicityUse caution in patients with acute myocardial infarction; may increase myocardial oxygen demand; during acute coronary syndrome, digoxin administered IV may be used to slow a rapid ventricular response and improve left ventricular function in the acute treatment of atrial fibrillation associated with severe LV function and heart failure or hemodynamic instabilityMonitor serum concentration closely when used for rate control in patients with atrial fibrillation; serum concentration that is not properly controlled are associated with increased risk of mortalityConsider use of digoxin only in heart failure with reduced ejection fraction when symptoms remain despite guideline-directed medical therapy; withdrawal of digoxin in clinically stable patients with heart failure may lead to recurrence of heart failure symptomsIn hypertrophic cardiomyopathy, outflow obstruction may worsen due to positive inotropic effects of digoxin; avoid use unless used to control ventricular response with atrial fibrillation; in the absence of atrial fibrillation, digoxin is potentially harmful in the treatment of dyspnea in patients with hypertrophic cardiomyopathyAvoid rapid IV administration in digitalized patients; may produce serious arrhythmiasNot necessary to routinely reduce or hold digoxin therapy prior to elective electrical cardioversion for atrial fibrillation; however, exclusion of digoxin toxicity is necessary prior to cardioversion; whithold digoxin and delay cardioversion until toxicity subsides if signs of digoxin excess existExperience with digoxin in pregnant women over several decades, based on published retrospective clinical studies and case reports, has not led to the identification of a drug associated risk of major birth defects, miscarriage or adverse maternal and fetal outcomesUntreated underlying maternal conditions (eg, heart failure, atrial fibrillation) during pregnancy pose a risk to the mother and fetusThe digoxin dose received through breastfeeding is up to 4% of the neonatal maintenance dosage, which is unlikely to be clinically relevantThere are no data on the effects of digoxin on the breastfed infant or the effects on milk productionA: Generally acceptable.
On a once-daily dosing schedule, the concentration of digoxin will be 10% to 25% lower when sampled at 24 versus 8 hours, depending upon the patient’s renal function. 2002 Digoxin works by inhibiting an enzyme (called Na-K ATPase) responsible for the exchange of sodium for other electrolytes in cells. Digoxin is the first line agent for atrial fibrillation and congestive heart failure.
Applies to the following strengths: 250 mcg/mL (0.25 mg/mL); 50 mcg/mL (0.05 mg/mL); 100 mcg/mL (0.1 mg/mL); 125 mcg (0.125 mg); 250 mcg (0.25 mg); 500 mcg (0.5 mg); 50 mcg (0.05 mg); 100 mcg (0.1 mg); 200 mcg (0.2 mg); 62.5 mcg (0.0625 mg); 187.5 mcg (0.1875 mg)Total loading dose: Administer one-half the total loading dose initially (all formulations), then give one-fourth the total loading dose every 6 to 8 hours for two doses (IV and tablets), or give additional fractions every 4 to 8 hours (oral solution).Total loading dose: Administer one-half the total loading dose initially (all formulations), then give one-fourth the total loading dose every 6 to 8 hours for two doses (IV and tablets), or give additional fractions every 4 to 8 hours (oral solution).Total loading dose: Administer one-half the total loading dose initially (all formulations), then give one-fourth the total loading dose every 6 to 8 hours for two doses (IV and tablets), or give additional fractions every 4 to 8 hours (oral solution).For recommended maintenance doses according to lean body weight and renal function, the manufacturer product information should be consulted.This drug should be used at the lowest effective dose in order to achieve therapeutic efficacy and minimize side effects.Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. 1974;14(10):525-35. The therapeutic benefit of digoxin is greater in patients with ventricular dilatation.

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