DIGOXIN injectable

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
• 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