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Category:
Description:
Indications:
-
Congestive
heart failure, atrial fibrillation, atrial flutter
-
Paroxysmal
atrial tachycardia (PAT)
-
Cardiogenic
shock
Contraindications:
-
Ventricular
tachycardia
-
Ventricular
fibrillation
Precautions:
-
Pregnancy
category C; passes readily into fetus; excretion into breast milk
unknown
-
Hypokalemia,
hypomagnesemia, hypercalcemia, hypothyroidism, sick sinus syndrome
-
Severe
pulmonary disease, hepatic disease, AV block, acute MI, hepatic
disease
-
Wolff-Parkinson-White
syndrome
Adverse
Reactions (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 (PVC’s), ventricular fibrillation, ventricular
tachycardia
-
EENT:
visual disturbances (blurred, yellow or green halo effect)
-
GI:
abdominal discomfort, diarrhea, hemorrhagic necrosis of the
intestines, nausea, vomiting
-
HEME:
eosinophilia, thrombocytopenia
-
SKIN:
rash
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Dosage:
Administered
orally (tablet)
-
Adult:
Loading dose PO (rapid) 0.6mg, followed by 0.4mg, then 0.2mg at
every 4-6 hour intervals; (slow) 0.2mg 2 times daily for 4 days;
maintenance dose PO 0.05-0.3mg daily.
Dosage reduction not needed in renal function impairment
-
Child:
Loading dose PO <1 year 0.045 mg/kg, 1-2 years 0.04 mg/kg,
>2 years 0.03 mg/kg divided into 3, 4, or more portions with >6
hours between doses; maintenance dose PO 1/10 loading dose
Drug
interactions:
-
Alprazolam,
amiodarone, diltiazem, verapamil, bepridil, nitrendipine, quinidine,
carvedilol, cyclosporine, erythromycin and tetracycline (change in
bacterial flora causing effect may persist for months),
hydroxychloroquine, NSAIDS, azole antifungals, omeprazole,
lansoprazole, propafenone, quinine, spironolactone, tacrolimus:
May cause increased digoxin levels
-
Charcoal:
reduced digitalis levels
-
Beta-Blockers:
Potentiation of bradycardia
-
Succinylcholine:
increased arrhythmias
Special
considerations:
-
Listed
adverse effects are mostly signs of toxicity
-
When
digitalis indicated digoxin
is 1st line drug because of shorter ½-life and faster clearance in
the event toxicity develops.
-
Rule
out digitalis toxicity if nausea, vomiting, or arrhythmias develop
-
Therapeutic
range: 9-25 ng/ml
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Source:
Operational Medicine 2001, Health
Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau
of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington,
D.C., 20372-5300
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