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digitoxin

C01AA04

Forms & Strengths

Oral tablets: 0.1 mg
Oral tablets: 0.2 mg

Adult Dosing

Digitalization (rapid): 0.6 to 1.2 mg divided in doses over 24 hours
Digitalization (slow): 0.2 mg daily for 4 days, then maintenance
Maintenance: 0.05 to 0.15 mg orally once daily

Pediatric Dosing

Safety and efficacy not well established in pediatric patients; use is generally avoided
Neonates/Infants (if used): Total digitalisizing dose 0.02 to 0.03 mg/kg divided over 24 hours

Indications

Heart failure with reduced ejection fraction
Atrioventricular nodal tachyarrhythmias (e.g., rate control in atrial fibrillation)

Mechanism of Action

Inhibition of the Na+/K+-ATPase membrane pump in myocardial cells
Increases intracellular sodium, leading to increased intracellular calcium via Na+/Ca2+ exchanger
Enhances myocardial contractility (positive inotrope)
Decreases conduction velocity through the AV node and increases vagal tone

Contraindications

Ventricular fibrillation
Second- or third-degree atrioventricular block without a pacemaker
Wolff-Parkinson-White syndrome associated with atrial fibrillation
Known hypersensitivity to digitoxin or other digitalis glycosides
Hypertrophic obstructive cardiomyopathy (unless coexisting heart failure/atrial fibrillation)

Adverse Reactions

Cardiac arrhythmias (PVCs, bigeminy, trigeminy, AV block)
Nausea, vomiting, anorexia, diarrhea
Visual disturbances (blurred vision, yellow-green halos/xanthopsia)
Central nervous system effects (fatigue, dizziness, headache, confusion)

Drug Interactions

Potassium-depleting diuretics (thiazides, loop diuretics) increase risk of digitalis toxicity
Amiodarone, quinidine, and verapamil increase serum digitoxin levels
Inducers of CYP3A4 (e.g., rifampin, barbiturates) decrease digitoxin efficacy
Beta-blockers and non-dihydropyridine calcium channel blockers enhance AV nodal blockade

Curated Content: Needs Vetting Before Put to Clinical Use