Digoxin: Reliable Heart Rate Control and Symptom Relief
Digoxin
| Product dosage: 0.25mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
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| 360 | $0.42
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Synonyms | |||
Digoxin is a time-tested cardiac glycoside indicated for the management of atrial fibrillation and the treatment of heart failure. It works primarily by increasing the force of myocardial contractility and modulating the electrical conduction system of the heart, specifically at the atrioventricular (AV) node. Its inotropic and chronotropic effects make it a cornerstone in specific cardiovascular therapeutic regimens, particularly when symptom control and ventricular rate regulation are paramount. Careful therapeutic drug monitoring is essential due to its narrow therapeutic index.
Features
- Contains digoxin as the active pharmaceutical ingredient
- Available in oral tablet (e.g., 62.5 mcg, 125 mcg, 250 mcg) and intravenous injection formulations
- Derived from the leaves of Digitalis lanata
- Exhibits positive inotropic and negative chronotropic effects
- Characterized by a long half-life (approximately 36–48 hours in patients with normal renal function)
- Requires careful dosage individualization based on renal function, body weight, and clinical context
Benefits
- Provides effective control of ventricular rate in patients with atrial fibrillation
- Improves symptoms of heart failure by enhancing cardiac output and reducing pulmonary congestion
- Can be used in both outpatient and inpatient settings with established monitoring protocols
- Offers a cost-effective treatment option within guideline-directed medical therapy
- May reduce hospitalization rates in certain heart failure populations when used appropriately
- Allows for flexible dosing schedules in maintenance therapy due to its long half-life
Common use
Digoxin is primarily used for two key indications: the management of chronic heart failure with reduced ejection fraction (HFrEF) to improve symptoms and reduce hospitalizations, and for controlling ventricular rate in patients with atrial fibrillation, especially when other rate-control agents are ineffective or contraindicated. It is often used as an adjunct therapy alongside beta-blockers, ACE inhibitors, and diuretics. Its use is generally reserved for symptomatic patients despite optimal standard care, or in specific clinical scenarios where its unique electrophysiological properties are advantageous.
Dosage and direction
Dosing is highly individualized and must be based on lean body weight, renal function (estimated glomerular filtration rate), and clinical goals (e.g., rate control vs. inotropic support). A typical digitalizing (loading) dose may be used in acute settings, followed by a lower daily maintenance dose. For most adults with normal renal function, maintenance doses usually range from 125 mcg to 250 mcg once daily. Dosing in renal impairment requires significant reduction and frequent monitoring. Administration should occur at the same time each day, and tablets may be taken with or without food. Intravenous administration is reserved for hospitalized patients under continuous cardiac monitoring.
Precautions
Regular assessment of renal function, electrolytes (particularly potassium, magnesium, and calcium), and clinical status is mandatory. Hypokalemia, hypomagnesemia, and hypercalcemia can predispose to toxicity. Use with extreme caution in the elderly and those with underlying conduction system disease. Periodic ECG monitoring is advised. Patients should be educated to recognize and report early signs of toxicity such as nausea, vomiting, visual disturbances (e.g., yellow-green halos), or new arrhythmias. Digoxin should generally be avoided or used at very low doses in patients with amyloidosis or constrictive pericarditis.
Contraindications
Digoxin is contraindicated in patients with known hypersensitivity to digoxin or other digitalis preparations. Its use is also contraindicated in ventricular fibrillation, unless due to supraventricular tachycardia with rapid ventricular response that has not responded to other agents. It should not be used in patients with second- or third-degree heart block (without a permanent pacemaker), Wolff-Parkinson-White syndrome (due to risk of paradoxical acceleration of ventricular response), or in cases of known digoxin toxicity.
Possible side effect
Common side effects include nausea, vomiting, diarrhea, headache, dizziness, and fatigue. More serious adverse effects are often related to toxicity and include life-threatening arrhythmias (e.g., ventricular tachycardia, advanced heart block), profound bradycardia, and visual changes (xanthopsia). Neuropsychiatric effects such as confusion, nightmares, and depression can also occur, particularly in the elderly. Gynecomastia is a rare but documented side effect with long-term use.
Drug interaction
Digoxin has numerous clinically significant interactions. Diuretics (especially loop and thiazide diuretics) can cause hypokalemia, increasing toxicity risk. Drugs like amiodarone, verapamil, diltiazem, quinidine, and cyclosporine can significantly increase digoxin serum levels. Concomitant use with sympathomimetics or other arrhythmogenic drugs may increase the risk of serious arrhythmias. Concomitant use with succinylcholine may increase the risk of arrhythmias in the perioperative period. Macrolide antibiotics, tetracyclines, and propafenone may also elevate digoxin concentrations.
Missed dose
If a dose is missed, it should be taken as soon as remembered on the same day. If it is not remembered until the next day’s dose is due, the missed dose should be skipped entirely. Patients should never take a double dose to make up for a missed one, as this significantly increases the risk of acute toxicity. Consistent daily timing is important for maintaining stable serum levels, but occasional minor deviations are acceptable if the above guidance is followed.
Overdose
Digoxin overdose is a medical emergency and can be fatal. Symptoms include severe nausea and vomiting, hyperkalemia, profound bradycardia, visual disturbances, and life-threatening ventricular arrhythmias. Management includes immediate discontinuation of the drug, cardiac monitoring, correction of electrolyte abnormalities, and administration of digoxin-specific antibody fragments (digoxin immune Fab) for severe, life-threatening toxicity. Activated charcoal may be beneficial if ingestion was recent. Supportive care, including temporary pacing for bradyarrhythmias, is often necessary.
Storage
Store digoxin tablets at room temperature (15°–30°C or 59°–86°F), in a tightly closed container, and protect from light and moisture. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Do not store in bathrooms or other areas with high humidity. Intravenous solutions should be stored according to manufacturer specifications and protected from light.
Disclaimer
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting or altering any treatment regimen. Never disregard professional medical advice or delay in seeking it because of something you have read herein. Dosing and indications may vary based on individual patient factors and latest clinical guidelines.
Reviews
“Digoxin remains a valuable tool in our arsenal for rate control in permanent atrial fibrillation, especially in patients with heart failure where beta-blockers are insufficient. Its inotropic effect provides an added benefit.” – Cardiologist, 15 years experience.
“While we have many new agents, digoxin’s low cost and efficacy in specific populations keep it relevant. It demands respect and careful monitoring, but when used correctly, it significantly improves quality of life for my CHF patients.” – Heart Failure Specialist.
“Managing digoxin therapy requires vigilance due to its narrow therapeutic window, but the clinical benefits in symptomatic rate control are often unmistakable. Patient education on toxicity symptoms is critical.” – Clinical Pharmacist, Cardiology.