DIGOXIN injectable

Prescription under medical supervision

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 elderly 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 -