Digoxin Oral: Dosing and Precautions

Therapeutic action

Cardiotonic.

Indications

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

Forms and strengths

• 250 micrograms (0.25 mg) tablet.

Dose

Adult: 125 to 250 micrograms (0.125 to 0.25 mg) once daily.

Reduce the dose by half in older patients and in patients with renal impairment.

Duration

According to clinical response.

Contra-indications, adverse effects, precautions

• Do not administer to patients with bradycardia, ill-defined arrhythmia, or coronary artery disease.
• It is essential to monitor heart rate in the initial stage of treatment.
• Overdose may cause gastrointestinal disturbances, blurred vision, headache, confusion, and conduction or rhythm disorders. If so, reduce dose or stop treatment.
• Do not combine with calcium, particularly by IV route, because serious arrhythmias may occur.
• Monitor combination with amiodarone, macrolides, itraconazole, quinine, and chloroquine because digoxin concentration increases.
• Potassium-depleting drugs such as diuretics, corticosteroids, and amphotericin B increase the risk of digoxin toxicity.
• If possible, monitor serum potassium in patients taking potassium-depleting drugs and serum creatinine in patients with renal impairment.
• Do not administer simultaneously with antacids; administer 2 hours apart.
• Pregnancy: no contra-indication.
• Breast-feeding: no contra-indication.