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Due to narrow margin between therapeutic and toxic dose, patients should be kept under close surveillance.
Therapeutic action
- Cardiotonic
Indications
- Supraventricular arrhythmias (fibrillation, flutter, paroxysmal tachycardia)
- Heart failure
Forms and strengths, route of administration
- 500 micrograms ampoule (250 micrograms/ml, 2 ml) for slow IV injection or infusion in 5% glucose or 0.9% sodium chloride
Dosage
- Adult:
- Loading dose: 500 to 1000 micrograms
The loading dose can be administered either by intravenous infusion as a single dose given over 2 hours minimum or in divided doses, by slow IV injections over 5 minutes minimum. - Maintenance dose: change to oral treatment
- Loading dose: 500 to 1000 micrograms
- Reduce the dose by one half in older patients and in patients with renal impairment.
Contra-indications, adverse effects, precautions
- Do not administer to patients with bradycardia, ill defined arrhythmia, coronary artery disease.
- It is essential to monitor heart rate in the initial stage of treatment.
- Narrow margin between therapeutic and toxic dose.
- May cause in the event of overdose: gastrointestinal disturbances (nausea, vomiting, diarrhoea), blurred vision, headache, confusion, conduction and rhythm disorders. If so, reduce dose or stop treatment.
- Do not combine with calcium, particularly by IV injection (serious arrhythmias).
- Monitor combination with:
- amiodarone, macrolides, itraconazole, quinine, chloroquine (increased digoxin concentration);
- potassium-depleting drugs: diuretics, corticoids, amphotericin B (increased risk of digoxin toxicity).
- Monitor if possible serum potassium level in patients taking potassium-depleting drugs and serum creatinine level in patients with renal impairment.
- Pregnancy: no contra-indication
- Breast-feeding: no contra-indication
Remarks
- A loading dose may be administered in arrhythmias if a rapid digitalisation is required. It is usually not required for heart failure.
Storage
– Below 25 °C