8/3/2019 Digoxin Drug Card

1/1

DIGOXIN(Generic) LANOXICAPS / LANOXIN(Trade) CLASSIFICATION: Cardiac Glycosides

USES: Heart Failure; Atrial fibrillation and atrial flutter; Paroxysmal atrial tachycardia

ACTION: increases force of Myocardial contractions; prolongs refractory period of the AV node; Decreases conduction through the SA an d AV nodes.

THERAPEUTIC EFFECT: Increase cardiac output (positive inotropic effect) and slowing of the heart rate (negative chronotropic effect)

DOSAGE FOR ADULTS:

IV: Initial Loading/Digitalizing dose: 0.5-1 mg given as 50% of the dose initially and one quarter of the initial dose in each of the 2 subsequent doses at

6-12h intervals

PO: Initial Loading/Digitalizing dose: 0.75-1.5mg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at

6-12h intervals. For geriatric patients, initial dose should not exceed 0.125mg. Maintenance Dose: 0.125-0.5mg/day as tablets or 0.35-0.5mg/day as

gelatin capsules

PHARMACOKINETICS:

Absorption: PO: 60-80% absorbed from tablets; 70-85% absorbed from elixir; 90-100% absorbed from liquid-filled capsules

Distribution: Widely distributed

Metabolism and Excretion: Excreted almost entirely unchanged by the kidneys

Half-Life: 36-48h; increased with renal impairment

ROUTE ONSET PEAK DURATION (with normal renal function)

PO 30-120 minutes 2-8 hours 2-4 days

IM 30 minutes 4-6 hours 2-4 days

IV 5-30 minutes 1-4 hours 2-4 days

CONTRAINDICATIONS: Hypersensitivity; Uncontrolled ventricular arrhythmias; AV block (without pacemaker); Idiopathic hypertrophic subaorticstenosis; Constrictive pericarditis; Known alcohol intolerance (for Digoxin elixir only)

USE WITH CAUTION: Hypokalemia (increase risk of digoxin toxicity); Hypercalcemia (increase risk of digoxin toxicity); with diuretics;

Hypothyroidism; Geriatric Patients; Myocardial Infarction; Renal Impairment; Obesity

ADVERSE EFFECTS:

Most Common: Tachycardia, headache, dizziness, mental disturbance, N&V, diarrhea, anorexia, blurred or yellow vision

CNS: Fatigue, weakness

CV: Arrhythmias, bradycardia, ECG Changes, AV Block, SA Block (block = impairment in conduction)GI: Anorexia, diarrhea

Hemat: Thrombocytopenia

Metabolic: Electrolyte imbalances with acute digoxin toxicity

DRUG INTERACTIONS:

Thiazide and Loop Diuretics, piperacillin, ticarcillin, amphotericin B, corticosteroids, and excessive use of laxatives may cause hypokalemia andincrease the risk of Digoxin toxicity.

Amiodarone, some benzodiazepines, cyclosporine, diphenoxylate, indomethacin, itraconazole, propafenone, quinidine, quinine, spironolactone,and verapamil may increase levels and lead to toxicity

Levels may be decreased by some antineoplaxtics, activated charcoal, cholestyramine, colestipol, kaolin/pectin, metoclopramide, penicillamine,rifampin, or sulfasalazine

Additive bradycardia may occur with beta-blockers, diltiazem, verapamil, clonidine, and other antiarrhythmics Use with sympathomimetics may increase risk of arrhythmias Thyroid hormones may decrease therapeutic effects

NURSING CONSIDERATIONS:

Measure liquid precisely. Obtain written parameters for when medication is held. Changes in rate or rhythm may indicate toxicity. Expect reduction in

dosage if changing from PO form to parenteral form. Give IV injections over 5 minutes or longer

ASSESSMENT:

Before: Monitor Apical Pulse for 1 minute; if