Digoxin 50 Mcg/ml (0.05 Mg/ml) Drp
Overview
What is this medicine?
How to Use This Medicine
To get the most benefit from your medication, follow these steps:
Take your medication exactly as directed by your doctor.
Read all the information provided with your medication and follow the instructions carefully.
Take your medication at the same time every day to establish a routine.
Continue taking your medication as prescribed by your doctor or healthcare provider, even if you start to feel better.
When taking a liquid dose, make sure to:
Measure the dose carefully using the measuring device provided with the medication.
If a measuring device is not included, ask your pharmacist for one to ensure accurate dosing.
Storing and Disposing of Your Medication
To keep your medication safe and effective:
Store it at room temperature, away from direct light.
Keep it in a dry place, avoiding bathrooms and other areas with high humidity.
Store all medications in a secure location, out of reach of children and pets.
Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your pharmacist.
Check with your pharmacist for guidance on the best way to dispose of medications, and consider participating in local drug take-back programs.
What to Do If You Miss a Dose
If you miss a dose, follow these steps:
Take the missed dose as soon as you remember.
If it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule.
Do not take two doses at the same time or take extra doses to make up for a missed dose.
Lifestyle & Tips
- Take your medicine at the same time each day.
- Do not stop taking digoxin without talking to your doctor.
- Monitor your pulse rate daily as instructed by your doctor. Report if it's too slow or irregular.
- Maintain a balanced diet and adequate fluid intake to prevent dehydration and electrolyte imbalances.
- Avoid sudden changes in diet, especially those high in fiber, as they can affect absorption.
- Report any new medications, over-the-counter drugs, or herbal supplements to your doctor or pharmacist, as many can interact with digoxin.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Condition-Specific Dosing:
Pediatric Dosing
Dose Adjustments
Renal Impairment:
Hepatic Impairment:
Pharmacology
Mechanism of Action
Pharmacokinetics
Absorption:
Distribution:
Elimination:
Pharmacodynamics
Safety & Warnings
Side Effects
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Severe dizziness or fainting
Persistent upset stomach or vomiting
Diarrhea that does not subside
Changes in vision
Seeing halos or bright colors around lights
Unexplained weight loss
Decreased appetite
Feeling extremely tired or weak
Abnormal heart rhythms, including fast or slow heartbeat
New or worsening irregular heartbeat
Hallucinations (seeing or hearing things that are not there)
Changes in behavior or mood
Confusion
Black, tarry, or bloody stools
Vomiting blood or coffee ground-like material
Enlarged breasts
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it is essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
Dizziness or headache
* Stomach pain
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Nausea, vomiting, loss of appetite, diarrhea (common early signs of toxicity)
- Unusual tiredness, weakness, or confusion
- Blurred vision, seeing yellow or green halos around lights, or other visual disturbances
- Slow or irregular heartbeat, palpitations, or fainting spells
Before Using This Medicine
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
If you have a history of heart problems or have recently had a heart attack, as this may affect your ability to take this medication safely.
This list is not exhaustive, and it is crucial to discuss all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, with your doctor and pharmacist. They will help you determine if it is safe to take this medication in combination with your other medications and health conditions.
Remember, do not start, stop, or change the dose of any medication without first consulting your doctor to ensure your safety.
Precautions & Cautions
To ensure your safety while taking this drug, follow your doctor's instructions for monitoring your blood pressure and heart rate. Additionally, have your blood work and other laboratory tests done as directed by your doctor. This includes regular blood tests to measure the level of digoxin in your body. It is crucial to have your blood drawn before taking your daily dose of digoxin (take the medication after the lab test). If you have any questions or concerns, discuss them with your doctor.
Please note that this medication may interfere with certain laboratory tests. Therefore, it is vital to inform all your healthcare providers and laboratory personnel that you are taking this drug.
If you consume a diet high in bran or fiber, notify your doctor, as this may affect the medication's absorption. Also, if you are scheduled to undergo a cardioversion procedure to restore a normal heart rhythm, inform your doctor that you are taking this medication.
To prevent accidental exposure, keep this medication out of the reach of children, as ingestion can be fatal. If a child accidentally takes this drug, seek immediate medical attention.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects. Similarly, if the patient is a child, this medication should be used with caution, as the risk of certain side effects may be higher in children.
If you are pregnant, planning to become pregnant, or breastfeeding, inform your doctor. It is necessary to discuss the potential benefits and risks of taking this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Severe nausea, vomiting, abdominal pain
- Profound bradycardia (very slow heart rate)
- Various cardiac arrhythmias (e.g., AV block, ventricular tachycardia, ventricular fibrillation)
- Lethargy, confusion, disorientation, seizures
- Hyperkalemia (especially in acute overdose)
What to Do:
Seek immediate medical attention. Call 911 or Poison Control (1-800-222-1222). Treatment may include activated charcoal (if acute ingestion), correction of electrolyte imbalances, antiarrhythmics, and in severe cases, Digoxin Immune Fab (DigiFab) fragments.
Drug Interactions
Major Interactions
- Amiodarone (increases digoxin levels significantly)
- Dronedarone (increases digoxin levels)
- Quinidine (increases digoxin levels)
- Verapamil (increases digoxin levels)
- Diltiazem (increases digoxin levels)
- Propafenone (increases digoxin levels)
- Macrolide antibiotics (e.g., Clarithromycin, Erythromycin - can increase digoxin levels by altering gut flora)
- Tetracycline antibiotics (can increase digoxin levels by altering gut flora)
- Cyclosporine (increases digoxin levels)
- Spironolactone (can interfere with digoxin assays and increase levels)
- Ritonavir (increases digoxin levels)
- St. John's Wort (decreases digoxin levels)
- Rifampin (decreases digoxin levels)
- Cholestyramine (decreases digoxin absorption)
- Antacids (decreases digoxin absorption)
- Kaolin-pectin (decreases digoxin absorption)
- Sucralfate (decreases digoxin absorption)
- Diuretics (especially loop and thiazide diuretics - can cause hypokalemia, increasing digoxin toxicity risk)
- Amphotericin B (can cause hypokalemia, increasing digoxin toxicity risk)
Moderate Interactions
- Beta-blockers (additive bradycardia)
- Calcium supplements (hypercalcemia can potentiate digoxin toxicity)
- ACE inhibitors/ARBs (may increase potassium, potentially reducing digoxin effect, but also reduce renal clearance of digoxin in some cases)
- NSAIDs (may impair renal function, affecting digoxin clearance)
- Metoclopramide (may decrease digoxin absorption)
- Omeprazole (may increase digoxin levels)
- Carvedilol (increases digoxin levels)
Minor Interactions
- Psyllium (may decrease absorption)
Monitoring
Baseline Monitoring
Rationale: Electrolyte imbalances, especially hypokalemia, hypomagnesemia, and hypercalcemia, can precipitate or worsen digoxin toxicity.
Timing: Before initiation and periodically during therapy.
Rationale: Digoxin is primarily renally eliminated; impaired renal function necessitates dose adjustment.
Timing: Before initiation and periodically during therapy.
Rationale: Hypothyroidism can decrease digoxin clearance, while hyperthyroidism can increase it.
Timing: Before initiation.
Rationale: To assess baseline cardiac rhythm, PR interval, and QTc interval. Digoxin can cause various arrhythmias and conduction abnormalities.
Timing: Before initiation.
Routine Monitoring
Frequency: At least 7-14 days after initiation or dose change, then every 6-12 months, or more frequently if toxicity is suspected or renal function changes.
Target: Heart Failure: 0.5-0.9 ng/mL; Atrial Fibrillation: 0.8-2.0 ng/mL (for rate control).
Action Threshold: Levels >2.0 ng/mL are generally considered toxic, but toxicity can occur at lower levels, especially with electrolyte imbalances. Clinical status is paramount.
Frequency: Periodically, especially if on diuretics or other interacting drugs, or if symptoms of toxicity arise.
Target: Potassium: 3.5-5.0 mEq/L; Magnesium: 1.7-2.2 mg/dL; Calcium: 8.5-10.2 mg/dL.
Action Threshold: Any deviation, particularly hypokalemia, requires immediate correction.
Frequency: Periodically, especially in elderly patients or those with comorbidities affecting renal function.
Target: Normal ranges.
Action Threshold: Significant changes warrant digoxin dose adjustment.
Frequency: Daily (patient self-monitoring) or at each clinical visit.
Target: Individualized, typically 60-100 bpm for adults (or target for AF rate control).
Action Threshold: Bradycardia (<60 bpm in adults), irregular pulse, or new arrhythmias should prompt evaluation.
Symptom Monitoring
- Nausea
- Vomiting
- Anorexia
- Diarrhea
- Fatigue
- Weakness
- Headache
- Dizziness
- Confusion
- Delirium
- Visual disturbances (blurred vision, yellow/green halos, scotomas)
- Cardiac arrhythmias (bradycardia, AV block, premature ventricular contractions, ventricular tachycardia, ventricular fibrillation)
Special Patient Groups
Pregnancy
Digoxin is Pregnancy Category C. While it crosses the placenta, it has been used safely in pregnant women for cardiac conditions. Fetal monitoring for heart rate and rhythm is recommended. Dosage may need adjustment due to increased renal clearance during pregnancy.
Trimester-Specific Risks:
Lactation
Digoxin is excreted into breast milk in small amounts. The amount ingested by the infant is generally considered clinically insignificant. Monitor breastfed infants for signs of digoxin toxicity (e.g., bradycardia, vomiting).
Pediatric Use
Dosing is weight-based and varies significantly by age group (neonates, infants, children, adolescents). Neonates and infants have a higher volume of distribution and may require higher mg/kg doses. Close monitoring of serum levels, heart rate, and ECG is crucial due to narrow therapeutic index and variability in pharmacokinetics.
Geriatric Use
Elderly patients are more susceptible to digoxin toxicity due to age-related decline in renal function, lower muscle mass (affecting creatinine clearance estimation), and increased likelihood of polypharmacy and electrolyte imbalances. Lower initial doses and careful titration are recommended. Close monitoring of renal function, electrolytes, and serum digoxin levels is essential.
Clinical Information
Clinical Pearls
- Digoxin has a narrow therapeutic index; careful dosing and monitoring are critical.
- Toxicity can occur even within the 'therapeutic' range, especially with electrolyte disturbances (hypokalemia, hypomagnesemia, hypercalcemia).
- Always check serum potassium, magnesium, and renal function before initiating and regularly during therapy.
- Many drugs interact with digoxin, particularly those affecting P-glycoprotein or renal function. Review all concomitant medications.
- The oral solution (0.05 mg/mL) is often preferred for pediatric patients or those requiring precise dose adjustments.
- Symptoms of toxicity can be vague (GI upset, fatigue) or severe (cardiac arrhythmias, visual disturbances).
- Digoxin Immune Fab (DigiFab) is the antidote for severe, life-threatening digoxin toxicity.
Alternative Therapies
- For Heart Failure: ACE inhibitors, ARBs, Beta-blockers, Mineralocorticoid Receptor Antagonists (MRAs), SGLT2 inhibitors, ARNI (Sacubitril/Valsartan), Ivabradine.
- For Atrial Fibrillation (rate control): Beta-blockers (e.g., Metoprolol, Atenolol), Calcium Channel Blockers (e.g., Verapamil, Diltiazem), Amiodarone (for rhythm control or refractory rate control).