Digoxin

Digoxin Brand Names

Digitek | Lanoxicaps | Lanoxin | Lanoxin Pediatric

What is Digoxin

Digoxin is a cardiac glycoside similar to digitoxin, although the pharmacokinetic profiles differ between the two drugs.

The ancient Egyptians used cardiac glycosides as a poison, and the Romans used them as a cardiovascular tonic.

In 1785, Withering published his famous book on foxglove (i.e., digitalis purpurea) and its uses.

Digoxin is indicated for the treatment of congestive heart failure and to control ventricular rate in patients with atrial fibrillation. The use of digoxin to control ventricular rate in patients with chronic atrial fibrillation has declined in recent years; its use is being replaced by more effective rate control agents such as calcium channel blockers.

While digoxin increases left ventricular ejection fraction, improves symptoms, and reduces the need for hospitalization in patients with systolic heart failure, overall mortality is not affected.

Although digoxin has been used for decades in patients with heart failure (HF), ACE inhibitors have replaced digoxin as first line therapy for HF due to systolic dysfunction, but digoxin continues to be used as adjunctive therapy for heart failure.

When used to treat patients with diastolic heart failure (HF with normal ejection fraction) and normal sinus rhythm who were also receiving ACE inhibitors, digoxin is not associated with a benefit on overall mortality or cardiovascular morbidity.

In patients with atrial fibrillation or atrial flutter, calcium-channel blockers, such as verapamil and diltiazem, are generally more effective than digoxin for controlling ventricular rate.

Although digoxin is used for the treatment and/or prophylaxis of supraventricular arrhythmias due to reentry mechanisms, calcium antagonists are generally preferred. The first commercially available digoxin products approved by the FDA went on the market in 1952.

Indications

1. atrial fibrillation
2. atrial flutter
3. heart failure
4. paroxysmal supraventricular tachycardia (PSVT)
5. paroxysmal supraventricular tachycardia (PSVT) prophylaxis

For ventricular rate control in patients with chronic atrial fibrillation and/or atrial flutter†; or for the treatment of narrow-complex paroxysmal supraventricular tachycardia (PSVT)† or for paroxysmal supraventricular tachycardia (PSVT) prophylaxis† in patients without a delta wave on ECG during sinus rhythm; or for the treatment of congestive heart failure.

Side Effects

1. abdominal pain
2. anorexia
3. anxiety
4. atrial fibrillation
5. atrial tachycardia
6. AV block
7. blurred vision
8. bowel ischemia
9. bowel necrosis
10. bradycardia
11. cardiac arrest
12. confusion
13. delirium
14. depression
15. diarrhea
16. dizziness
17. gynecomastia
18. hallucinations
19. headache
20. hyperkalemia
21. hypokalemia
22. maculopapular rash
23. nausea
24. palpitations
25. PR prolongation
26. premature atrial contractions (PACs)
27. premature ventricular contractions (PVCs)
28. rash
29. sinus tachycardia
30. ST-T wave changes
31. supraventricular tachycardia (SVT)
32. thrombocytopenia
33. ventricular fibrillation
34. ventricular tachycardia
35. visual impairment
36. vomiting
37. weakness
38. xanthopsia

Monitoring Parameters

• ECG
• serum calcium
• serum creatinine/BUN
• serum magnesium
• serum potassium

Contraindications

• acute myocardial infarction
• Adams-Stokes syndrome
• AV block
• bradycardia
• breast-feeding
• cardiomyopathy
• carotid sinus hypersensitivity
• constrictive pericarditis
• cor pulmonale
• diarrhea
• electrolyte imbalance
• geriatric
• hepatic disease
• hypercalcemia
• hyperkalemia
• hypertension
• hyperthyroidism
• hypocalcemia
• hypokalemia
• hypomagnesemia
• hypothyroidism
• hypoxemia
• idiopathic hypertrophic subaortic stenosis
• infants
• intramuscular administration
• labor
• malabsorption syndrome
• myocarditis
• myxedema
• neonates
• obstetric delivery
• pregnancy
• premature neonates
• pulmonary disease
• renal disease
• renal failure
• renal impairment
• sick sinus syndrome
• ventricular arrhythmias
• ventricular fibrillation
• ventricular tachycardia
• Wolff-Parkinson-White syndrome

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