Digoxin is a derivative of the leaves of digitalis plant. Digoxin is used in healing and treatment of a heart failure and constant AF (atrial fibrillation).

One should not use digoxin if one has ventricular fibrillation. Ventricular fibrillation is a heart rhythm disorder of the lower chambers of the heart (ventricles) which allow the blood to flow out of the heart.

How Does Digoxin Work?

One of the uses of digoxin is in the treatment of heart failure also knows as atrial fibrillation. It works by inhibiting Na-K-ATPase enzyme, the one liable for the trade of sodium for other electrolytes in cells. In return, this will increase the quantity of calcium inside the heart. It also affects the electrical system inside the heart itself, and finally the manner in which the heart beats.

Effectiveness of Digoxin

Effectiveness of Digoxin

Digoxin effectively improves and regulates the heart beat and heart rhythm. Digoxin is also used to prevent heart failure. Another use of Digoxin is in treatment of a heart rhythm disorder of the atria called atrial fibrillation. Atria is the upper chambers if the heart which allows blood to flow in to the heart.

  • Dosing of digoxin with a higher than standard dose (loading dose), followed with a smaller, more steady and sustainable dose, may be initiated by some medical professionals. This is done to allow a gradual transition to reach effective blood levels. Two weekly intervals are enough for digoxin to reach its peak levels, and any further dosage should be done within these two intervals.
  • Prior to electrical cardio version, digoxin needs to reduced or completely stopped for a short period of time.
  • Although the ideal range of digoxin levels in the blood is between 0.5 and 2ng/mL, doctors should construe each and every individual levels of digoxin based on the each and every individual response.

The effective and response of digoxin is excellent. Some effects of the drug may be noticeable shortly after incipient initiation; however, full effects of the drug can take up to two weeks after the preliminary drug initiation. Dosing change may also be the reason for these changes.

What is the Recommended Dosage of Digoxin?

Common Dosage of Digoxin for Adults suffering from Congestive Heart Failure:

Loading Dose:

Anywhere from 8 to 12 mcg/kg is the peak of digoxin that provides remedial effect within the most patients with heart failure and normal sinus rhythm. This level also provides minimum toxicity.

One should manage the loading dose into several parts, meaning the first dose should contain half of the total dose. Following this one should administer the other parts in 6 to 8 hour intervals. One should examine patient's clinical response before continuing with the rest of the dosage. One should look for patient's response to the initial dose, and accordingly change and calculate the remaining doses in accordance to the loading dose.

  • Digoxin Tablets. 500 to 750 mcg of digoxin produces a noticeable effect within 0.5 to 2 hours. Maximal effect is achieved within 2 to 6 hours. Supplementary doses can be given in 6 to 8 hour intervals, until one notices the adequate effect on the patient. For a 70 kg patient to reach a peak body store of 8 to 12 mcg/kg, the amount needed for the tablets is from 750 to 125 mcg.
  • Digoxin Capsules. 400 to 6000 mcg of digoxin produces a noticeable effect within 0.5 to 2 hours. Maximal effect is achieved within 2 to 6 hours. Supplementary doses of 100 to 300 mcg can be given in 6 to 8 hour intervals, until one notices the adequate effect on the patient. For a 70kg patient to reach a peak body store of 8 to 12 mcg/kg, the amount needed for the capsules is from 6000 to 1000 mcg.
  • Digoxin Injection. 400 to 600 mcg of digoxin injected intravenously produces a noticeable effect within 5 to 30 minutes- Maximal effect is achieved within 1 to 4 hours. Supplementary doses of 100 to 300 mcg can be given in, carefully, within 6 to 8 hours intervals, until one notices the adequate effect on the patient. For a 70kg patient to reach a peak body store of 8 to 12 mcg/kg the amount of digoxin injected needs to be between 600 to 1000 mcg. This method is used for quicker digitalization. Tablets and capsules are used in further maintenance therapy.

Maintenance Dose. Research has shown that usage of digoxin tablets in treatment of patients with heart failure, have usually been dosed from 125 mcg to 500 mcg once daily. In this research it shown that the dose has been titrated accordingly with the patient's body weight, age, and renal function. A dose of 250 mcg per day in the therapy was generally initiated in patients under the age of 70 with good renal function.

Side Effects of Digoxin

Drastic side effects of Digoxin are likely to show in older adults who are sick of feeble. Frequent digoxin side effects may include:

If one is between the ages of 18 and 60, and does not take any other form of medications or has any other medical conditions, one may experience the following side effects of digoxin:

  • Abdominal pain, dizziness, anxiety, headache, weakness, and with the continuous use one may experience gynecomastia, also known as breast accretion in males.
  • One must take into account that there is a narrow line between toxic and remedial levels of digoxin. Different factors such as kidney function, age, weight, other interacting medications, as well as quantities of potassium intake, must be taken into account or it may upset the balance. One must have continuous supervising of digoxin and electrolyte levels.
  • Nausea, visual disturbances, arrhythmia, vomiting, weight loss, and arrhythmia, are all signs of toxicity.
  • People with particular types of arrhythmia, one of them is ventricular fibrillation, are not suitable for digoxin.
  • There is a list of medications that digoxin interacts with. Some of them are: antibiotics, indomethacin, atorvastatin, as well as other heart medications.

If you experience an allergic reaction to digoxin, get immediate medical help. One of the sings can be: difficulty breathing, swelling of face, lips, throat, or tongue, hives, etc…

Seek medical help immediately if you experience the following because of digoxin:

  • Vomiting, appetite loss, or nausea
  • Uneven heart rate
  • Tarry, bloody or black stools
  • Yellowed or blurred vision
  • Hallucinations, confusion, unexpected and unusual thoughts or behavior.

Conclusion

Being that digoxin is one of the oldest and one of the most controversial medications in effectively treating heart related diseases, it is almost always used with other, more standardized, medications. There is still a big debate about its benefits and risks in treatment of atrial fibrillation. Dosing has proven difficult because of various factors that can influence blood levels of digoxin. As mentioned above, there is always a risk between taking too much or too little.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: July 27, 2017

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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