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CARDIOVASCULAR SYSTEM › CARDIAC THERAPY › CARDIAC GLYCOSIDES › Digitalis glycosides
acetyldigitoxin
C01AA01
Forms & Strengths
- Oral tablets: 0.1 mg, 0.2 mg
Adult Dosing
- Digitalization: 0.4 to 0.6 mg initially, followed by 0.2 to 0.4 mg every 4 to 6 hours until clinical response or toxicity occurs
- Maintenance: 0.1 to 0.2 mg daily, adjusted based on clinical response and serum drug levels
Pediatric Dosing
- Safety and efficacy in pediatric patients not well established; dosing requires specialized pediatric cardiology consultation
Indications
- Heart failure with reduced ejection fraction
- Rate control in chronic atrial fibrillation
Mechanism of Action
- Inhibition of the Na+/K+-ATPase membrane pump in myocardial cells, leading to increased intracellular sodium, enhanced calcium influx via Na+/Ca2+ exchanger, and positive inotropic effect
- Increases vagal tone and decreases sympathetic activity, slowing atrioventricular nodal conduction
Contraindications
- Ventricular fibrillation
- Ventricular tachycardia
- Digitalis toxicity
- Second- or third-degree atrioventricular block without a pacemaker
- Hypersensitivity to acetyldigitoxin or other digitalis glycosides
- Wolff-Parkinson-White syndrome with pre-excitation
Adverse Reactions
- Cardiac arrhythmias (ventricular premature beats, bigeminy, trigeminy, AV block)
- Anorexia, nausea, vomiting, diarrhea
- Visual disturbances (blurred vision, yellow-green halos)
- Central nervous system effects (fatigue, dizziness, headache, confusion)
Drug Interactions
- Quinidine, verapamil, and amiodarone increase serum cardiac glycoside concentrations
- Loop and thiazide diuretics cause hypokalemia and hypomagnesemia, increasing the risk of digitalis toxicity
- Sympathomimetics and calcium salts increase the risk of cardiac arrhythmias
- Indducers of P-glycoprotein may decrease absorption or efficacy
Curated Content: Needs Vetting Before Put to Clinical Use