Digoxin: Precision Cardiac Support for Heart Rhythm and Function
Digoxin
| Product dosage: 0.25mg | |||
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Synonyms | |||
Digoxin remains a cornerstone in the management of certain cardiac conditions, offering a time-tested approach to controlling heart rate and improving symptoms in patients with heart failure and atrial fibrillation. As a cardiac glycoside derived from Digitalis lanata, it exerts positive inotropic effects to enhance myocardial contractility and negative chronotropic effects to regulate ventricular rate. Its narrow therapeutic index necessitates careful dosing and monitoring, but when used appropriately under expert supervision, it provides significant clinical benefits for eligible patients. This product card provides comprehensive information for healthcare professionals regarding the proper use, safety considerations, and therapeutic applications of digoxin.
Features
- Contains digoxin as the active pharmaceutical ingredient
- Available in tablet and injectable formulations
- Derived from purified digitalis glycosides
- Standardized potency for consistent dosing
- Multiple strength options (typically 62.5 mcg, 125 mcg, 250 mcg tablets)
- Long half-life allowing once-daily dosing in maintenance therapy
- Well-established pharmacokinetic profile
- measurable serum concentrations for therapeutic monitoring
Benefits
- Enhanced Cardiac Output: Improves myocardial contraction efficiency in systolic heart failure
- Rate Control: Effectively manages ventricular response in atrial fibrillation
- Symptom Relief: Reduces dyspnea, fatigue, and exercise intolerance in heart failure patients
- Chronic Management: Provides stable long-term control with once-daily dosing
- Complementary Therapy: Works synergistically with other heart failure medications
- Established Safety Profile: Extensive clinical experience spanning decades of use
Common use
Digoxin is primarily indicated for the treatment of mild to moderate heart failure with reduced ejection fraction, particularly when symptoms persist despite optimal doses of diuretics, ACE inhibitors, and beta-blockers. It is also approved for controlling ventricular response rate in patients with chronic atrial fibrillation. The medication may be used as adjunctive therapy in managing supraventricular tachyarrhythmias, including atrial flutter and paroxysmal atrial tachycardia. Clinical use typically involves patients who require additional symptom control beyond standard heart failure regimens or those who cannot tolerate alternative rate-control medications.
Dosage and direction
Dosing must be individualized based on patient factors including age, renal function, body weight, and concomitant medications. For most adults with normal renal function, the typical digitalizing dose is 0.75-1.5 mg administered orally in divided doses over 24 hours, followed by a maintenance dose of 0.125-0.25 mg daily. In elderly patients or those with renal impairment, reduced doses are necessary. The intravenous formulation is reserved for urgent situations with a loading dose of 0.5-1 mg administered slowly in divided doses. Serum digoxin levels should be monitored, with the therapeutic range generally considered to be 0.5-2.0 ng/mL, though lower levels (0.5-0.9 ng/mL) are often targeted in heart failure patients.
Precautions
Careful patient selection and monitoring are essential due to digoxin’s narrow therapeutic index. Renal function must be assessed before initiation and periodically during therapy, as approximately 60-80% of digoxin is excreted unchanged in urine. Electrolyte imbalances, particularly hypokalemia, hypomagnesemia, and hypercalcemia, can predispose patients to toxicity even at therapeutic doses. Thyroid function should be evaluated as both hyperthyroidism and hypothyroidism can affect digoxin requirements. Elderly patients require particular caution due to age-related decreases in renal function and lean body mass. Regular assessment of clinical response and serum drug levels is mandatory throughout treatment.
Contraindications
Digoxin is contraindicated in patients with known hypersensitivity to digoxin or other digitalis preparations. Additional absolute contraindications include ventricular fibrillation, significant sinus node dysfunction or second-degree or third-degree AV block without a functioning pacemaker, and certain types of hypertrophic cardiomyopathy. Relative contraindications include Wolff-Parkinson-White syndrome with atrial fibrillation due to risk of paradoxical acceleration of ventricular response, constrictive pericarditis, cardiac amyloidosis, and renal failure requiring dialysis. Concomitant use with intravenous calcium preparations is contraindicated due to risk of serious arrhythmias.
Possible side effect
The most frequently observed adverse effects are cardiac arrhythmias, including premature ventricular contractions, paroxysmal atrial tachycardia with block, and various degrees of heart block. Gastrointestinal symptoms such as nausea, vomiting, diarrhea, and abdominal pain are common. Neurological effects may include fatigue, headache, dizziness, and visual disturbances characterized by yellow-green halos around objects (chromatopsia). Less common effects include gynecomastia, thrombocytopenia, and rash. Most adverse effects are dose-dependent and often indicate toxicity, particularly cardiac arrhythmias which require immediate medical attention.
Drug interaction
Numerous significant drug interactions require careful management. Diuretics that cause potassium depletion increase toxicity risk. Amiodarone, verapamil, quinidine, and cyclosporine can increase digoxin serum concentrations. Concomitant use with beta-blockers or calcium channel blockers may excessively slow heart rate. Sympathomimetics may increase the risk of arrhythmias. Antibiotics such as erythromycin and tetracycline may increase digoxin absorption from the gut. Antacids, cholestyramine, and certain anticancer drugs may decrease digoxin absorption. Any medication changes in patients taking digoxin warrant consideration of potential interactions and possible dosage adjustments.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should never double the dose to make up for a missed administration. Consistent timing is important for maintaining stable serum concentrations, but occasional minor variations in dosing time are generally not clinically significant given digoxin’s long half-life. Patients should be instructed to maintain a consistent schedule and to contact their healthcare provider if multiple doses are missed.
Overdose
Digoxin overdose constitutes a medical emergency requiring immediate treatment. Symptoms may include severe nausea and vomiting, hyperkalemia, visual disturbances, and life-threatening cardiac arrhythmias. Management includes discontinuation of digoxin, cardiac monitoring, correction of electrolyte abnormalities, and administration of digoxin-specific antibody fragments (digoxin immune Fab) for serious toxicity. Activated charcoal may be effective if administered soon after ingestion. Temporary cardiac pacing may be necessary for significant bradyarrhythmias. Serum digoxin levels and continuous ECG monitoring are essential in managing overdose situations.
Storage
Tablets should be stored at controlled room temperature (20-25°C or 68-77°F) in their original container, protected from light and moisture. The injection formulation should be stored according to manufacturer specifications, typically at room temperature and protected from light. All digoxin products should be kept out of reach of children and pets. Unused medication should be properly disposed of according to local regulations, not flushed down toilets or drains. Patients should be advised to check expiration dates and not to use medication that appears discolored or shows signs of deterioration.
Disclaimer
This information is intended for healthcare professionals and should not replace personalized medical advice. Digoxin requires prescription and professional supervision. Treatment decisions must be based on individual patient assessment by qualified healthcare providers. The prescribing physician should be consulted for specific dosage recommendations and monitoring requirements. Patients should not initiate or adjust digoxin therapy without medical supervision. Full prescribing information including boxed warnings should be reviewed before administration.
Reviews
Clinical studies and decades of therapeutic use demonstrate digoxin’s efficacy in appropriate patient populations. The DIG trial (Digitalis Investigation Group) showed that digoxin reduces hospitalizations for heart failure while having a neutral effect on overall mortality. Many cardiologists report sustained symptomatic improvement in properly selected patients, particularly those with persistent symptoms despite guideline-directed medical therapy. Reviews consistently emphasize the importance of careful patient selection, appropriate dosing, and vigilant monitoring to maximize benefits while minimizing risks. The medication continues to hold value in specific clinical scenarios despite the development of newer heart failure therapies.