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Digitoxin (Crystodigin)

Category:

  • Cardiac

Description:

  • Antidysrhythmic; cardiac glycoside

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

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

 


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.

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