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13 Cards in this Set
- Front
- Back
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digoxin indications
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heart failure,
supraventricular arrhyhmias (atrial filbrillation and atrial flutter) |
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digoxin cautions
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recent MI
sick sinus syndrome thyoid disease reduce dose in eldery severe respiratory disease; hypokalaemia, hypomagnesaemia, hypercalcaemia, and hypoxia (risk of digitalis toxicity); monitor serum electrolytes and renal function; avoid rapid intravenous administration (risk of hypertension and reduced coronary flow); |
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digoxin contraindications
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intermittent complete heart block,
second degree AV block; supraventricular arrhythmias associated with accessory conducting pathways e.g. Wolff-Parkinson-White syndrome; ventricular tachycardia or fibrillation; hypertrophic cardiomyopathy (unless concomitant atrial fibrillation and heart failure—but use with caution); myocarditis; constrictive pericarditis (unless to control atrial fibrillation or improve systolic dysfunction—but use with caution) |
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Digoxin renal impairment
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reduce dose and monitor plasma-digoxin concentration;
toxicity increased by electrolyte disturbances |
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Digoxin- pregnancy
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may need dosage adjustment
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Digoxin- breast feeding
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amount to small to be harmful
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Digoxin- side effects
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nausea, vomiting, diarrhoea;
arrhythmias, conduction disturbances; dizziness; blurred or yellow vision; rash, eosinophilia; |
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Digoxin dose
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Rapid digitalisation, for atrial fibrillation or flutter, by mouth, 0.75–1.5 mg over 24 hours in divided doses
Maintenance, for atrial fibrillation or flutter, by mouth, according to renal function and initial loading dose; usual range 125–250 micrograms daily Heart failure (for patients in sinus rhythm), by mouth, 62.5–125 micrograms once daily Emergency loading dose, for atrial fibrillation or flutter, by intravenous infusion (but rarely necessary), 0.75–1 mg over at least 2 hours (see also Cautions) then maintenance dose by mouth on the following day |
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Digoxin dose 2
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The above doses 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. Digoxin doses in the BNF may differ from those in product literature. For plasma concentration monitoring, blood should be taken at least 6 hours after a dose
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Digoxin common black dot interactions
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• Amiodarone- increased plasma conc of digoxin
• Ciclosporin- plasma conc of digoxin increased (increased risk of toxicity) • Diltiazem- plasma concentration of digoxin increased by diltiazem • Diuretics, loop, thiazide and related • Lercanidipine- plasma conc of digoxin increased • Nicardipine plasma conc of digoxin increased • Nifedipine plasma conc of digoxin increased • Quinine plasma conc of digoxin increased • Spironolactone plasma conc of digoxin increased • St johns wort plasma conc of digoxin reduced • Verapamil plasma conc of digoxin increased, increased risk of AV block and bradycardia |
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digoxin common non-black dot interactions
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• Antacids- absorption of digoxin reduced
• Atorvastatin- plasma conc of digoxin reduced • Beta blockers- increased risk of AV block and bradycardia • Calcium salts- arrhythmias (large doses of calcium salts • Captopril- plasma conc of digoxin increased • corticosteroids increased risk of hypokalaemia • Macrolides- plasma conc of digoxin increased (increased risk of toxicity) • Methotrexate- abs of digoxin tabs reduced • PPI plasma conc of digoxin slightly increased • Rifampicin plasma conc of digoxin reduced • salbutamol plasma conc of digoxin reduced |
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Digoxin toxicity, if occurs digoxin should be withdrawn
Digoxin-specific antibody fragments are available when life-threatening overdose |
drowsiness,
nausea/vomiting loss of appetite (anorexia) diarrhea disturbed colour vision confusion dizziness agitation depression affect heart rate ad cardiac dysrhythmias hypokalemia! |
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digoxin extra
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monitor plasma-dogxin conc during maintenance is not necessary unless provelsm are suspected
hypokalaemia- toxicity, managing my giving potassium-spaing diuretic or potassium supplementation |
