Digoxin Injectable: Dosing and Precautions

Therapeutic action

Cardiotonic.

Indications

• Supraventricular arrhythmias such as fibrillation, flutter, and paroxysmal tachycardia.
• Heart failure.

Forms and strengths, route of administration

• 500 micrograms ampoule, 250 micrograms/ml in 2 ml, for slow IV injection or infusion in 5% glucose or 0.9% sodium chloride.

Dose

• Adult loading dose: 500 to 1000 micrograms.
• The loading dose can be administered either by intravenous infusion as a single dose over at least 2 hours or in divided doses by slow IV injections over at least 5 minutes.
• Maintenance dose: change to oral treatment.
• Reduce the dose by one half in older patients and in patients with renal impairment.

Contra-indications, adverse effects, precautions

Due to the narrow margin between therapeutic and toxic dose, patients should be kept under close surveillance.

It is essential to monitor heart rate in the initial stage of treatment.

• Do not administer to patients with bradycardia, ill-defined arrhythmia, or coronary artery disease.
• May cause in overdose gastrointestinal disturbances, blurred vision, headache, confusion, and conduction or rhythm disorders.
• Do not combine with calcium, particularly by IV injection.
• Monitor combination with amiodarone, macrolides, itraconazole, quinine, chloroquine, and potassium-depleting drugs.
• If possible, monitor serum potassium in patients taking potassium-depleting drugs and serum creatinine in patients with renal impairment.
• Pregnancy: no contra-indication.
• Breast-feeding: no contra-indication.