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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- 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 for patients with renal insufficiency) .
Roughly one half the total loading dose should be given intravenously as the first dose, with the remaining portion divided and administered every six to eight hours (e.g., 400 to 600 mcg [0.4 to 0.6 mg] initially, followed by 100 to 300 mcg [0.1 to 0.3 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 600 to 1000 mcg (0.6 to 1 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 injection maintenance doses required for estimated peak body stores of 10 mcg per kg of body weight generally have ranged from 75 mcg to 350 mcg (0.075 to 0.35 mg), administered once a day, the dose 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 response .
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-In newborns, digoxin renal clearance is decreased (especially in premature infants) and digoxin doses should be adjusted accordingly .
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 .
Digitalization-
The following total amounts divided into three or more doses, with the initial portion representing approximately one half the total, doses then being administered every four to eight hours, with careful assessment of clinical response before each additional dose .
If the patient's clinical response requires a change from the calculated loading dose of digoxin, the calculation of the maintenance dose should be based upon the amount actually given .
Premature infants:
Intravenous, 15 to 25 mcg (0.015 to 0.025 mg) per kg of body weight .
Full-term infants:
Intravenous, 20 to 30 mcg (0.02 to 0.03 mg) per kg of body weight .
Infants 1 month to 2 years of age:
Intravenous, 30 to 50 mcg (0.03 to 0.05 mg) per kg of body weight .
Children 2 to 5 years of age:
Intravenous, 25 to 35 mcg (0.025 to 0.035 mg) per kg of body weight .
Children 5 to 10 years of age:
Intravenous, 15 to 30 mcg (0.015 to 0.03 mg) per kg of body weight .
Children 10 years of age and older:
Intravenous, 8 to 12 mcg (0.008 to 0.012 mg) per kg of body weight .
Maintenance (begun within twenty-four hours after digitalization )-
Premature infants:
Intravenous, 20 to 30% of the total digitalizing dose, divided and administered in two or three equal portions per day .
Full-term infants and older children:
Intravenous, 25 to 35% of the total digitalizing dose, divided and administered in two or three equal portions per day . |
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MAXIMUM PEDIATRIC
DOSE:
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ELDERLY DOSE:
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