Digitoxin
(Crystodigin) |
Category:
Description:
Indications:
-
Congestive
heart failure, atrial fibrillation, atrial flutter
-
Paroxysmal
atrial tachycardia (PAT)
-
Cardiogenic
shock
Contraindications:
-
Ventricular
tachycardia
-
Ventricular
fibrillation
Precautions:
-
Pregnancy
category C; passes readily into fetus; excretion into breast milk
unknown
-
Hypokalemia,
hypomagnesemia, hypercalcemia, hypothyroidism, sick sinus syndrome
-
Severe
pulmonary disease, hepatic disease, AV block, acute MI, hepatic
disease
-
Wolff-Parkinson-White
syndrome
Adverse
Reactions (Side Effects):
-
CNS:
anorexia, apathy, confusion, delirium, disorientation, drowsiness, EEG
abnormalities, hallucinations, headache, mental depression, neuralgia,
psychosis, restlessness, seizures, weakness
-
CV:
atrial fibrillation, AV block, bradycardia, premature ventricular
contractions (PVC’s), ventricular fibrillation, ventricular
tachycardia
-
EENT:
visual disturbances (blurred, yellow or green halo effect)
-
GI:
abdominal discomfort, diarrhea, hemorrhagic necrosis of the
intestines, nausea, vomiting
-
HEME:
eosinophilia, thrombocytopenia
-
SKIN:
rash
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Dosage:
Administered
orally (tablet)
-
Adult: Loading dose PO (rapid) 0.6mg, followed by 0.4mg, then 0.2mg at
every 4-6 hour intervals; (slow) 0.2mg 2 times daily for 4 days;
maintenance dose PO 0.05-0.3mg daily. Dosage reduction not needed in renal function impairment
-
Child: Loading dose PO <1 year 0.045 mg/kg, 1-2 years 0.04 mg/kg,
>2 years 0.03 mg/kg divided into 3, 4, or more portions with >6
hours between doses; maintenance dose PO 1/10 loading dose
Drug
interactions:
-
Alprazolam,
amiodarone, diltiazem, verapamil, bepridil, nitrendipine, quinidine,
carvedilol, cyclosporine, erythromycin and tetracycline (change in
bacterial flora causing effect may persist for months),
hydroxychloroquine, NSAIDS, azole antifungals, omeprazole,
lansoprazole, propafenone, quinine, spironolactone, tacrolimus: May cause increased digoxin levels
-
Charcoal:
reduced digitalis levels
-
Beta-Blockers:
Potentiation of bradycardia
-
Succinylcholine:
increased arrhythmias
Special
considerations:
-
Listed
adverse effects are mostly signs of toxicity
-
When
digitalis indicated digoxin is 1st line drug because of shorter ½-life and faster clearance in
the event toxicity develops.
-
Rule
out digitalis toxicity if nausea, vomiting, or arrhythmias develop
-
Therapeutic
range: 9-25 ng/ml
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The information contained here is an
abbreviated summary. For more detailed and complete information, consult the
manufacturer's product information sheets or standard textbooks
Source: Operational Medicine 2001, Health
Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau
of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington,
D.C., 20372-5300
This information is provided by The Brookside Associates. The Brookside
Associates, LLC. is a private organization, not affiliated with any governmental
agency. The opinions presented here are those of the author and do not
necessarily represent the opinions of the Brookside Associates or the Department
of Defense. The presence of any advertising on these pages does not constitute
an endorsement of that product or service by either the US Department of Defense
or the Brookside Associates. All material presented here is unclassified.
C. 2009, 2014, All Rights Reserved
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