Digoxin - Instructions For Use, Indications, Doses, Analogues

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Digoxin

Instructions for use:

1. 1. Release form and composition
2. 2. Indications for use
3. 3. Contraindications
4. 4. Method of application and dosage
5. 5. Side effects
6. 6. Special instructions
7. 7. Drug interactions
8. 8. Analogs
9. 9. Terms and conditions of storage
10. 10. Terms of dispensing from pharmacies

Prices in online pharmacies:

from 31 rub.

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Digoxin is a cardiotonic drug, cardiac glycoside.

Release form and composition

Dosage forms:

• Tablets: white or almost white, flat-cylindrical, engraved with "D" on one side and bevel (10 pcs. In blisters, in a cardboard box 1, 2, 3, 5 or 10 packs; 50 pcs. In polymer or glass (dark) jars, in a cardboard box 1 can; 50 pcs. in blisters, in a cardboard box 1 or 2 packs; 50 pcs. in polypropylene bottles, in a cardboard box 1 bottle; 50 pcs. in polypropylene cases, in a cardboard box 1 pencil case; 25 pcs. in blister packs, in a cardboard box 1, 2, or 4 packages);
• Solution for intravenous (IV) administration (1 ml in ampoules: in a cardboard box 10 ampoules; 5 pcs. In blisters, in a cardboard box 2 packages).

The active substance is digoxin:

• 1 tablet - 0.25 mg or 0.1 mg (children's Digoxin);
• 1 ml of solution - 0.25 mg.

Auxiliary components in the composition of tablets: lactose, sucrose, potato starch, calcium stearate, dextrose, talc.

Indications for use

Pills

• Chronic heart failure II (with clinical manifestations) and III-IV functional class according to NYHA classification - as part of complex therapy;
• Atrial fibrillation and atrial flutter of chronic and paroxysmal flow in tachysystolic form, especially with concomitant chronic heart failure.

Solution for intravenous administration

• Chronic heart failure with atherosclerotic cardiosclerosis, decompensated valvular heart disease, myocardial overload in arterial hypertension, especially with a constant form of atrial flutter or tachysystolic atrial fibrillation;
• Paroxysmal supraventricular arrhythmias (atrial flutter, atrial fibrillation, supraventricular tachycardia).

Contraindications

• Glycosidic intoxication;
• Wolff-Parkinson-White syndrome;
• Atrioventricular (AV) block II degree;
• Intermittent complete blockade;
• Breastfeeding period;
• Hypersensitivity to the drug.

With caution, comparing the benefits of therapy and the possible risk, Digoxin should be prescribed for AV block I degree, acute myocardial infarction, extrasystole, unstable angina pectoris, cardiac tamponade, isolated mitral stenosis with a rare heart rate (HR), renal and / or liver failure; elderly patients.

In addition, contraindications to the use of tablets:

• Age up to 3 years;
• Glucose-galactose malabsorption syndrome, lactase deficiency, lactose intolerance.

Patients with sick sinus syndrome without a pacemaker, risk of unstable conduction along the AV node, heart failure with pathology of diastolic function (restrictive cardiomyopathy, constrictive pericarditis, heart amyloidosis), indication of Morgagni-Adams-Stokes attacks in anamnesis, hypertrophic obstructive cardiomyopathy, cardiac asthma against the background of mitral stenosis (in the absence of a tachysystolic form of atrial fibrillation), arteriovenous shunt, hypoxia, pronounced dilatation of cardiac cavities, cor pulmonale; with alkalosis, hypothyroidism, myocarditis, obesity, as well as hypokalemia, hypomagnesemia, hypercalcemia, hypernatremia.

The solution should be used with caution in severe bradycardia, ventricular tachycardia, hypertrophic subaortic stenosis.

The use of Digoxin during pregnancy is prescribed for health reasons, if the clinical effect for the mother outweighs the potential harm to the fetus.

Method of administration and dosage

Pills

The tablets are taken orally.

The dose is selected individually, with caution. For patients who have taken cardiac glycosides before prescribing digoxin, the dose should be reduced.

Recommended dosage for patients over 10 years of age:

• Moderately rapid digitalization in emergency therapy: daily dose - 0.75-1.25 mg with a frequency of 2 times a day (under the control of electrocardiography (ECG) before each subsequent dose). After reaching saturation (24-36 hours), the patient is transferred to supportive therapy;
• Slow digitalization: 0.125-0.5 mg once a day for 5-7 days, after reaching saturation, they switch to supportive treatment;
• Supportive therapy: the dose is set individually, usually from 0.125 to 0.75 mg; the period of use is prescribed by the doctor, as a rule, the treatment is long.

For patients with chronic heart failure, the daily dose should not exceed 0.25 mg, with a body weight of more than 85 kg - no more than 0.375 mg.

For elderly patients, the drug is prescribed at a dose of 0.0625-0.125 mg.

When treating children 3-10 years old, a saturating dose is prescribed taking into account the weight of the child at 0.05-0.08 mg per 1 kg per day: with moderately rapid digitalization - within 3-5 days, slow digitalization - 6-7 days, supporting dose - 0.01-0.025 mg per 1 kg per day.

Solution for intravenous administration

The solution is injected intravenously drip or jet.

The doctor prescribes the dosage individually, based on clinical indications.

Recommended dosage:

• Moderately rapid digitalization - intravenously 0.25 mg 3 times a day (after which the patient is transferred to maintenance therapy - 0.125-0.25 mg intravenously once a day);
• Slow digitalization: up to 0.5 mg per day (in 1-2 doses);
• Paroxysmal supraventricular arrhythmia: daily dose - 0.25-1 mg (intravenous drip or stream).

The saturating dose for children is 0.05-0.08 mg per 1 kg of body weight per day; with moderately rapid digitalization, it is administered for 3-5 days, with slow digitalization - 6-7 days. The maintenance dose for children is 0.01-0.025 mg per 1 kg of the child's weight per day.

Side effects

Side effects associated with the use of tablets often occur due to overdose and are symptoms of digitalis intoxication:

• Cardiovascular system: ventricular premature beats; often - polytopic ventricular premature beats, bigeminia, ventricular paroxysmal tachycardia, sinus bradycardia, nodal tachycardia, sinoauricular (SA) block, AV block, atrial flutter and atrial fibrillation, a decrease in the ST segment on the ECG with the formation of a biphasic T wave;
• Nervous system: headache, sleep disturbances, dizziness, sciatica, neuritis, paresthesia, manic-depressive syndrome, fainting; rarely - disorientation, confusion, monochrome visual hallucinations (mainly with atherosclerosis in old age);
• Digestive system: abdominal pain, nausea, vomiting, anorexia, diarrhea, intestinal necrosis;
• Sense organs: decreased visual acuity, staining of visible objects in a yellow-green color, micro- and macropsia, flashing "flies" before the eyes;
• Hemostatic system and hematopoietic organs: nosebleeds, thrombocytopenic purpura, petechiae;
• Allergic reactions: skin rash; rarely - urticaria;
• Others: gynecomastia, hypokalemia.

Solution for intravenous administration

• Cardiovascular system: AV block, bradycardia, cardiac arrhythmias; isolated cases - thrombosis of mesenteric vessels;
• Nervous system: feeling tired, headache, dizziness; rarely - decreased visual acuity, xanthopsia, flashing of "flies" before the eyes, macro- and micropsia, scotomas; isolated cases - sleep disorders, depression, syncope, confusion, euphoria, delirious state;
• Digestive system: nausea, vomiting, anorexia, diarrhea;
• Endocrine system: gynecomastia (with prolonged use).

special instructions

Digoxin should be used under medical supervision, with regular ECGs and serum electrolytes.

The simultaneous administration of digitalis preparations with parenteral administration of calcium agents is contraindicated.

In chronic pulmonary heart disease, coronary insufficiency, imbalance in water and electrolyte balance, renal or hepatic insufficiency, it is necessary to reduce the dose, especially in elderly patients.

For patients with impaired renal excretory function, the dose of Digoxin should be reduced: with creatinine clearance (CC) 50-80 ml / min - by 50% of the usual dose, CC less than 10 ml / min - by 75%.

Care should be taken to select a dose for elderly patients, since in this category of patients, even with a functional disorder of the kidneys, CC may be within the normal range (when selecting a dose, the level of digoxin concentration in the blood serum should be taken into account).

In case of severe renal failure (CC less than 15 ml / min), control of the digoxin content in the blood serum should be carried out 1 time in 2 weeks.

In idiopathic subaortic stenosis, the use of Digoxin causes an increase in the severity of obstruction.

With mitral stenosis, cardiac glycosides are prescribed with concomitant right ventricular failure or atrial fibrillation.

Care should be taken to prescribe with AV blockade of the 1st degree (treatment should be accompanied by regular ECG monitoring, if necessary - pharmacological prophylaxis by means of improving AV conductivity).

The risk of glycosidic intoxication increases with hypomagnesemia, hypokalemia, hypercalcemia, hypothyroidism, hypernatremia, cor pulmonale, severe dilatation of the heart cavities, myocarditis; in elderly patients. Therefore, when prescribing digoxin, digitalization is controlled using monitoring of its plasma concentration.

The patient should be informed about the mandatory implementation of the following recommendations:

• Do not change the dose yourself;
• Take the drug every day at the same time;
• Seek medical attention immediately if your heart rate is less than 60 beats per minute;
• If you miss a dose, take it as soon as you remember.

If the patient missed taking the drug for more than 2 days or wants to stop therapy, this should be reported to the attending physician.

It is necessary to consult a doctor if there is a rapid pulse, nausea, vomiting, diarrhea.

For planned surgery or emergency care, the patient should warn the doctor about taking Digoxin.

Patients with contact lenses during the treatment period should exclude their use.

The simultaneous use of other drugs without the permission of a doctor is undesirable.

The content of sucrose, lactose, potato starch, glucose in 1 tablet corresponds to 0.006 bread units.

Care should be taken when driving vehicles and mechanisms.

Drug interactions

The risk of developing the toxic effect of Digoxin increases with simultaneous use with calcium preparations, diuretics, insulin, glucocorticosteroids, amphotericin B, beta-adrenergic agonists and other drugs that cause electrolyte imbalance, and therefore the dose of the drug should be reduced when prescribed and should not be administered intravenously calcium salts.

When combined with triamterene, spironolactone, quinidine, amiodarone, slow calcium channel blockers, especially verapamil, the serum digoxin content increases.

With the simultaneous use of Digoxin:

• Cholestyramine, colestipol, neomycin, tetracycline, laxatives, sulfasalazine, neomycin, phenylbutazone, antacids (containing aluminum and magnesium salts), kaolin, pectin and other adsorbents - reduce its absorption in the intestine, blood concentration and therapeutic effect;
• Activated carbon, preparations of St. John's wort, kaolin, astringents, sulfasalazine, metoclopramide, proserin - reduce the bioavailability of the drug;
• Erythromycin, antibiotics with a broad spectrum of action - increase the bioavailability of Digoxin;
• Barbiturates, phenytoin, phenylbutazone, rifampicin, oral contraceptives, antiepileptic drugs (inducers of microsomal oxidation) can potentiate the metabolism of digoxin;
• Sodium phosphate, gluco- and mineralocorticosteroids, carbonic anhydrase inhibitors, amphotericin B, adrenocorticotropic hormone (ACTH), ethacrynic acid, bumetanide, furosemide, mannitol, indapamide, thiazide derivatives - can reduce the therapeutic effect and contribute to the development of side effects of the drug;
• Edrophonia chloride - increasing the tone of the parasympathetic nervous system, can lead to severe bradycardia;
• Quinine, quinidine - lead to a sharp increase in the concentration of digoxin;
• Indomethacin, spironolactone, captopril, slow calcium channel blockers - slow down the excretion of digoxin, increasing the risk of toxic effects of the drug;
• Thyroid hormones - increase the metabolism in the body (a mandatory increase in the dose of digoxin is required);
• Heparin - its anticoagulant effect decreases;
• Antiarrhythmics, pancuronium bromide, calcium salts, rauwolfia alkaloids, sympathomimetics, suxamethonium iodide - can cause heart rhythm disturbances;
• Amiodarone - increases the content of digoxin in the blood plasma to a toxic level (it is shown that the dose of digoxin is canceled or reduced by 2 times).

To reduce the toxic effects of cardiac glycosides, a solution of magnesium sulfate is used.

Digoxin distorts the data when conducting a myocardial perfusion study using thallium chloride (201 TI), reducing the degree of its accumulation at the points of damage to the heart muscle.

Analogs

Digoxin analogs are: Digoxin Grindeks, Digoxin Nycomed, Digoxin-NS., Digoxin TFT, Novodigal, Celanid.

Terms and conditions of storage

Store in a dark place at a temperature of 15-25 ° C. Keep out of the reach of children.

Shelf life: tablets - 2 years, solution - 5 years.

Terms of dispensing from pharmacies

Dispensed by prescription.

Digoxin: prices in online pharmacies

Drug name Price Pharmacy

Digoxin 250 mcg tablets 30 pcs. RUB 31 Buy

Digoxin 0.25 mg tablets 30 pcs. 35 RUB Buy

Digoxin 0.25 mg tablets 56 pcs. 35 RUB Buy

Digoxin Grindeks 0.25 mg tablets 50 pcs. 35 RUB Buy

Digoxin tablets 0.25mg 30pcs RUB 36 Buy

Digoxin 0.25 mg tablets 50 pcs. RUB 48 Buy

Digoxin tablets 0.25mg 56 pcs. RUB 72 Buy

Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!