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SIZE:
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GENERIC NAME:
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MANUFACTURER:
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UNIT:
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ADMINISTRATION ROUTE:
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FDA PREGNANCY GROUP:
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C
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INDICATIONS:
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SIDE EFFECTS:
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hyperkalemia |
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hypokalemia |
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impaired cognition |
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impotence |
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libido decrease |
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maculopapular rash |
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nausea/vomiting |
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paresthesias |
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photophobia |
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PR prolongation |
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premature ventricular contractions (PVCs) |
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pruritus |
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psychosis |
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sinus bradycardia |
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sinus tachycardia |
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ST-T wave changes |
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Stevens-Johnson syndrome |
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syncope |
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thrombocytopenia |
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ventricular tachycardia |
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visual impairment |
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weakness |
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xanthopsia |
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abdominal pain |
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anorexia |
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anxiety |
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atrial fibrillation |
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atrial tachycardia |
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AV block |
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blurred vision |
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confusion |
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constipation |
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delirium |
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depression |
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diarrhea |
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dizziness |
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drowsiness |
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erythema |
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fatigue |
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gynecomastia |
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hallucinations |
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headache |
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ABSOLUTE
CONTRAINDICATIONS :
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RELATIVE
CONTRAINDICATIONS : |
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acute myocardial infarction |
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Adams-Stokes syndrome |
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AV block |
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bradycardia |
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breast-feeding |
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cardiomyopathy |
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carotid sinus hypersensitivity |
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constrictive pericarditis |
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cor pulmonale |
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elderly |
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electrolyte imbalance |
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hepatic disease |
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hypercalcemia |
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hyperkalemia |
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hypertension |
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hyperthyroidism |
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hypocalcemia |
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hypokalemia |
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hypomagnesemia |
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hypothyroidism |
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hypoxemia |
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idiopathic hypertrophic subaortic stenosis |
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myxedema |
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pregnancy |
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pulmonary disease |
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renal disease |
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renal failure |
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renal impairment |
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sick sinus syndrome |
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ventricular arrhythmias |
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ventricular tachycardia |
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ADULT DOSE:
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Congestive heart failure-Digitalization-
Rapid digitalization is achieved by administering a loading dose based upon projected peak digoxin body stores (e.g., body stores of 8 to 12 mcg per kg of body weight in patients with heart failure and normal sinus rhythm; 6 to 10 mcg per kg of body weight for patients with renal insufficiency) : Oral, roughly one half the total loading dose given as the first dose, with the remaining portion divided and administered every six to eight hours (e.g., 500 to 750 mcg [0.5 to 0.75 mg] initially, followed by 125 to 375 mcg [0.125 to 0.375 mg] administered every six to eight hours) until an appropriate clinical response is achieved .
Before each additional dose is given, the patient's clinical response should be assessed carefully .
If the patient's clinical response requires a change from the calculated loading dose of digoxin, calculation of the maintenance dose should be based upon the amount actually given .
For a 70-kg patient to achieve 8 to 12 mcg per kg of body weight peak body stores, the usual amount administered is 750 to 1250 mcg (0.75 to 1.25 mg) .
Slow digitalization is achieved by beginning an appropriate maintenance dose (allowing digoxin body stores to accumulate slowly) and will be achieved in approximately five half-lives .
Depending upon the patient's renal function, digitalization by this method will take between one and three weeks .
Maintenance-
Digoxin maintenance doses for estimated peak body stores of 10 mcg per kg of body weight generally have ranged from 62.5 to 500 mcg (0.0625 to 0.5 mg), administered orally as one or two doses per day, the dosage titrated according to the patient's age, lean body weight, and renal function .
In patients digitalized with a loading dose, the subsequent maintenance dose can be calculated as a percentage of the loading dose .
Doses may be increased every two weeks according to clinical response .
Therapy is generally initiated at the following doses:
For patients up to 70 years of age:
Oral, 250 mcg (0.25 mg) once a day .
For patients 70 years of age and older or with impaired renal function:
Oral, 125 mcg (0.125 mg) once a day .
For patients with marked impaired renal function:
Oral, 62.5 mcg (0.0625 mg) once a day .
Atrial fibrillation, chronic-Doses should be titrated to the minimum dose that achieves the desired ventricular rate control without causing undesirable side effects . |
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MAXIMUM ADULT DOSE:
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PEDIATRIC DOSE:
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Congestive heart failure-Beyond the immediate newborn period, children generally require proportionally larger doses than adults on the basis of body weight or body surface area .
Children older than 10 years of age require adult dosages in proportion to their body weight .
Some researchers have suggested that infants and young children tolerate slightly higher serum digoxin concentrations than do adults .
For digitalization dosing of infants and children, see Digoxin Elixir USP or Digoxin Injection USP.
The following daily maintenance doses are based on average patient response for children with normal renal function .
Divided daily dosing is recommended for children up to 10 years of age:
Maintenance-
Children 2 to 5 years of age:
Oral, 10 to 15 mcg (0.01 to 0.015 mg) per kg of body weight .
Children 5 to 10 years of age:
Oral, 7 to 10 mcg (0.007 to 0.01 mg) per kg of body weight .
Children 10 years of age and older:
Oral, 3 to 5 mcg (0.003 to 0.005 mg) per kg of body weight . |
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MAXIMUM PEDIATRIC
DOSE:
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ELDERLY DOSE:
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