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digoxin

C01AA05

Forms & Strengths

Oral tablets: 62.5 mcg, 125 mcg, 250 mcg
Oral solution: 50 mcg/mL
Injection: 250 mcg/mL

Adult Dosing

Heart failure: 125 to 250 mcg orally once daily
Atrial fibrillation (rate control): 0.125 to 0.25 mg orally once daily
Digitalization (rapid): 0.5 to 1 mg given in divided doses over 24 hours

Pediatric Dosing

Neonates/Infants/Children: Dosing varies significantly by age and indication; consult specialized pediatric literature and calculate based on lean body weight
Maintenance: Typically 8 to 10 mcg/kg/day divided every 12 hours orally for children 2-5 years

Indications

Heart failure with reduced ejection fraction (HFrEF)
Atrial fibrillation (rate control)

Mechanism of Action

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

Contraindications

Ventricular fibrillation
Ventricular tachycardia
Hypersensitivity to digoxin
Second- or third-degree heart block (unless a functioning artificial pacemaker is present)
Wolff-Parkinson-White syndrome with pre-excitation

Adverse Reactions

Nausea, vomiting, diarrhea, anorexia
Visual disturbances (blurred vision, yellow-green halos)
Cardiac arrhythmias (bradycardia, heart block, ventricular tachycardia)
Dizziness, confusion, fatigue

Drug Interactions

P-glycoprotein inhibitors (e.g., amiodarone, verapamil, dronedarone) increase digoxin concentrations
Loop and thiazide diuretics cause hypokalemia and hypomagnesemia, increasing toxicity risk
Beta-blockers and non-dihydropyridine calcium channel blockers increase risk of bradycardia and AV block
Indducers of P-gp/CYP (e.g., rifampin, St. John's wort) decrease digoxin concentrations

Curated Content: Needs Vetting Before Put to Clinical Use