Digoxin

💊 What is Digoxin used for?

• •Mild to moderate heart failure in adults
• •Increasing heart muscle contraction (pumping strength) in pediatric patients with heart failure
• •Controlling the ventricular (lower chamber) response rate in adults with chronic atrial fibrillation

How it works

Digoxin is one of the cardiac (digitalis) glycosides, a group of drugs that have specific effects on the heart muscle. The label says it increases left ventricular ejection fraction and improves heart failure symptoms, such as exercise ability, and reduces heart failure-related hospital stays. The label also says it has no effect on death rates. Where possible, it should be used together with a diuretic and an ACE inhibitor.

How it is usually taken

• •The label says the dose is based on factors such as age, lean body weight, and kidney function. Treatment may start with a loading dose followed by daily maintenance dosing, or with maintenance dosing alone. Doses may be adjusted every 2 weeks based on clinical response, blood drug levels, and signs of toxicity. The label says a liquid form (digoxin solution) may be used for infants, young children, or people with very low body weight. Follow the instructions from your prescriber or pharmacist.

Comes as

• •125 mcg yellow, round, scored tablets, debossed 'W 40' on the scored side
• •250 mcg white, round, scored tablets, debossed 'WW 41' on the scored side

⚠️ Digoxin side effects

🛑 Who should not take Digoxin, and who should be careful

The label says not to take it if

• 🚨You have ventricular fibrillation, which the label lists as a contraindication
• 🚨You have a known allergy to digoxin or other forms of digitalis. The label says reactions seen include unexplained rash, swelling of the mouth, lips, or throat, or difficulty breathing

Tell your doctor before taking it if

• •Tell your doctor and pharmacist about all prescription, over-the-counter, and herbal medicines, and about any new prescriptions, because the label says many drugs can interact with digoxin.
• •The label says to monitor and record your heart rate and blood pressure every day.
• •The label warns that people with Wolff-Parkinson-White syndrome who develop atrial fibrillation are at high risk of ventricular fibrillation.
• •The label says a pacemaker may need to be considered before treatment in people with sinus node disease or incomplete AV block.
• •The label says that advanced age, low body weight, kidney problems, and electrolyte abnormalities (such as low potassium, high calcium, or low magnesium) make toxicity more likely.
• •The label says digoxin is not recommended during an acute heart attack and should be avoided in people with myocarditis.
• •The label says the dose may need to be reduced or stopped for 1 to 2 days before electrical cardioversion for atrial fibrillation. Your doctor will decide this.

🔀 Digoxin with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •The label says digoxin has a narrow therapeutic index, so blood levels should be monitored when other drugs are started, changed, or stopped.
• •The label lists drugs that can increase digoxin levels by more than 50%, including amiodarone, captopril, clarithromycin, dronedarone, gentamicin, erythromycin, itraconazole, propafenone, quinidine, tetracycline, and verapamil.
• •The label lists drugs that increase digoxin levels by less than 50%, including atorvastatin, carvedilol, diltiazem, indomethacin, nifedipine, and spironolactone.
• •The label also lists drugs with unclear effects on digoxin levels, including alprazolam, azithromycin, ibuprofen, metformin, and omeprazole.
• •The label says digoxin is affected by P-glycoprotein inducers and inhibitors, which can change how the body absorbs, clears, and handles it.

Alcohol and food

The label does not say.

🤰 Digoxin in pregnancy and breastfeeding

Pregnancy

The label says that decades of experience with digoxin in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal and fetal outcomes. It also says untreated heart failure or atrial fibrillation during pregnancy poses risks to the mother and fetus. Digoxin crosses the placenta and is found in amniotic fluid, so the label advises monitoring newborns for signs of toxicity. Animal reproduction studies have not been conducted.

Breastfeeding

The label does not say.

🗓️ Storage, missed doses and taking too much

Storage

The label says to store digoxin tablets in a dry place at 20 to 25 degrees C (68 to 77 degrees F) and protect them from light. Keep out of reach of children. The label says it is dispensed in a tight, light-resistant, child-resistant container.

If a dose is missed

The label does not say.

If too much is taken

The label says signs of digoxin toxicity are generally similar to side effects but may be more frequent and more severe. The most common signs in adults are nausea, vomiting, loss of appetite, and fatigue. Very high levels can cause high potassium (hyperkalemia), especially in people with kidney impairment. Signs of toxicity become more frequent at levels above 2 ng/mL. The label text provided is cut off, so the full overdose guidance is not included here.

🗒️ Questions to ask about Digoxin

• Why am I taking digoxin, and what condition is it treating for me?
• How will my doctor check my digoxin blood levels, and how often?
• Which of my other medicines, including over-the-counter and herbal products, could change my digoxin levels?
• What heart rate and blood pressure readings should I record each day, and when should I call you?
• What early signs of digoxin toxicity should I watch for, such as nausea, vision changes, or confusion?
• Do I need a special liquid form of digoxin, and how should I store my tablets?

❓ Digoxin: frequently asked questions