Digoxin (Lanoxin, Lanoxicaps)

Category:

• Miscellaneous

Description:

• Antidysrhythmic, cardiac glycoside

Indications:

• CHF in patients receiving diuretics and ACE inhibitors

• Control ventricular response rate in atrial fibrillation

• Atrial flutter

• Paroxysmal atrial tachycardia (PAT)

• Cardiogenic shock

Contraindications:

• Ventricular tachycardia

• Ventricular fibrillation

Precautions:

• Pregnancy category C; passes readily into the fetus; incompatible with breast feeding

• Hypokalemia, hypomagnesemia, hypothyroidism, hypercalcemia

• Sick sinus syndrom, acute MI, AV block, Wolff-Parkinson-White syndrom

• severe pulmonary disease

Adverse Reactions (Side Effects):

• CNS: anorexia, apathy, confusion, delirium, disorientation, EEG abnormalities, hallucinations, headache, mental depression, neuralgia, seizures, weakness

• CV: atrial fibrillation, AV block, bradycardia, PVC’s, ventricular fibrillation, ventricular tachycardia

• EENT: blurred vision, yellow or green vision, halo effect vision

• GI: abdominal discomfort, diarrhea, hemorrhagic necrosis of the intestines, nausea, vomiting

• HEME: eosinophilia, thrombocytopenia

Dosage:

Administered orally (tablets, gelcaps, elixir) or intravenously (slowly over 5 minutes)

• Adult:

  • Loading dose (give ½ total dose initially, then ¼ dose in each of 2 subsequent doses at 8-12 hour intervals

    • IV 0.5-1mg

    • PO 0.75-1.5mg

  • maintenance dose 

    • IV 0.1-0.4mg daily

    • PO 0.125-0.5mg daily

• Child >10 years: 

  • Loading dose administered as for adult: 

    • IV 8-12 mcg/kg

    • PO 10-15 mcg/kg

  • maintenance dose 

    • IV 2-3 mcg/kg daily

    • PO 2.5-5 mcg/kg daily

• Child 5-10 years: 

  • Loading dose administered as for adult: 

    • IV 15-30 mcg/kg

    • PO 20-35 mcg/kg

  • maintenance dose 

    • IV 4-8 mcg/kg divided every 12 hours

    • PO 5-10 mcg/kg divided every 12 hours

• Child 2-5 years: 

  • Loading dose administered as for adult: 

    • IV 25-35 mcg/kg

    • PO 30-40 mcg/kg

  • maintenance dose 

    • IV 6-9 mcg/kg divided every 12 hours

    • PO 7.5-10 mcg/kg divided every 12 hours

• Child 1-24 months: 

  • Loading dose administered as for adult: 

    • IV 30-50 mcg/kg

    • PO 35-60 mcg/kg

  • maintenance dose 

    • IV 7.5-12 mcg/kg divided every 12 hours

    • PO 10-15 mcg/kg divided every 12 hours

• Full term infant: 

  • Loading dose as administered for adult: 

    • IV 20-3- mcg/kg

    • PO 25-35 mcg/kg

  • maintenance dose 

    • IV 5-8 mcg/kg divided every 12 hours

    • PO 6-10 mcg/kg divided every 12 hours

• Premature infant: 

  • Loading dose as administered for adult: 

    • IV 15-25 mcg/kg

    • PO 20-30 mcg/kg

  • maintenance dose 

    • IV 4-6 mcg/kg divided every 12 hours

    • PO 5-7.5 mcg/kg divided every 12 hours