Digoxin

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Synonyms / Brand Names:

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Dosing and Administration

Because the pharmacokinetics of Digoxin are complex, and because toxic levels of Digoxin are only slightly higher than therapeutic levels, Digoxin dosing can be difficult. The recommended approach is to:

  • estimate the patient’s daily maintenance dose;
  • adjust the estimate to account for patient-specific factors;
  • choose a dosing regimen;
  • monitor the patient for toxicity and for therapeutic effect, if possible; and
  • adjust the dose.

Estimated daily maintenance dose

  • Children > 2 years old - daily oral dose 10 mcg/kg/day
  • Prepubertal children - daily oral dose 10 mcg/kg/day
  • Adults - daily oral dose 3 mcg/kg/day

These doses will, in uncomplicated patients, tend to produce steady-state post-absorptive levels of 1 to 2 ng/mL, but the confidence limits around this range are wide.

ECG changes

ECG changes typical for digoxin use (digoxin = Lanoxin) are:

  • Oddly shaped ST-depression with 'scooped out' appearance of the ST segment (see figure)
  • Flat, negative or biphasic T wave
  • Short QT interval
  • Increased u-wave amplitude
  • Prolonged PR-interval
  • Sinus bradycardia

ECG changes typical for digoxin intoxication are:

  • Bradyarrhythmias:
    • AV block. Including complete AV block and Wenkebach.
  • Tachyarrhythmias:
    • Junctional tachycardia
    • Atrial tachycardia
    • Ventricular ectopia, bigemini, monomorphic ventricular tachycardia, bidirectional ventricular tachycardia

Intoxication can lead to an SA-block or AV-block, sometimes in combination with tachycardia. NB these effects are increased by hypokalemia. In extreme high concentrations rhythm disturbances (ventricular tachycardia, ventricular fibrillation, atrial fibrillation) may develop.




FDA Package Insert Resources
Indications, Contraindications, Side Effects, Drug Interactions, etc.

Calculate Creatine Clearance
On line calculator of your patients Cr Cl by a variety of formulas.

Convert pounds to Kilograms
On line calculator of your patients weight in pounds to Kg for dosing estimates.

Publication Resources
Recent articles, WikiDoc State of the Art Review, Textbook Information

Trial Resources
Ongoing Trials, Trial Results

Guidelines & Evidence Based Medicine Resources
US National Guidelines, Cochrane Collaboration, etc.

Media Resources
Slides, Video, Images, MP3, Podcasts, etc.

Patient Resources
Discussion Groups, Handouts, Blogs, News, etc.

International Resources
en Español






FDA Package Insert Resources

Indications

Contraindications

Side Effects

Drug Interactions

Precautions

Overdose

Instructions for Administration

How Supplied

Pharmacokinetics and Molecular Data

FDA label

FDA on Digoxin

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Publication Resources

Most Recent Articles on Digoxin

Review Articles on Digoxin

Articles on Digoxin in N Eng J Med, Lancet, BMJ

WikiDoc State of the Art Review

Textbook Information on Digoxin

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Trial Resources

Ongoing Trials with Digoxin at Clinical Trials.gov

Trial Results with Digoxin

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Guidelines & Evidence Based Medicine Resources

US National Guidelines Clearinghouse on Digoxin

Cochrane Collaboration on Digoxin

Cost Effectiveness of Digoxin

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Media Resources

Powerpoint Slides on Digoxin

Images of Digoxin

Podcasts & MP3s on Digoxin

Videos on Digoxin

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Patient Resources

Patient Information from National Library of Medicine

Patient Resources on Digoxin

Discussion Groups on Digoxin

Patient Handouts on Digoxin

Blogs on Digoxin

Digoxin in the News

Digoxin in the Marketplace

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International Resources

Digoxin en Español

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Adapted from the FDA Package Insert.