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Digoxin
Digoxin
Sr.no. Brand
name
Manufacturer
Dosage
form
Strength Storage
condition
1 Doxin Xenon
pharmaceutical s
liquid 50 mcg/ml Store in close
container, below
40C.
2 Digox Platinum
pharmaceuticals
Tablets
250 mcg Store in close
container, between
15-30c
3 Digoxin
Global
pharmaceuticals
Tablets
250 mcg
Store in close
container, between
15-30C.
4 Lanoxin
glaxosmithkine Tablets
250 mcg Store in close
container, between
15-30C.
5 Lonoxin
glaxosmithkine
Injection
0.5 mg/2ml Store below
40C.Donot freeze.
(References: Druginfosys.com)
PRODUCT DESCRIPTION
2:CHEMISTERY OF PRODUCT:
CHEMICAL CLASSS STRUCTURE PHYSICAL PROPERTIES
Digitalis/Cardi
-ac glycosides
Molecular
Formula: C
41
H
64
O
14
Molecular
Weight: 780.93846
Odorless white,
Melting point: 249.3C,
Crystalline
Insoluble in water,
Traces of the crystalline
form reduced the
dissolution rate and stability
of the amorphous form.
(REFERENCE: Martindale)
PHARMACOKINETICS
Bio-
availability
%age of
protein
binding
volume of
distribution
BBB/
placental
barrier
Time for
onset of
action
Time for
peak
blood
level
100% IV,
60-80%
orally
20%
6L/kg Can cross
placental
barrier/BBB
Oral 0.5
to 2
hour.
IV 5 to
30
minutes
2 -6
hours.
(oral)
1-4 hour.
(IV)
ABSORPTION: Occur by passive diffuse in the
proximal part of the small intestine.
(Druginfosys.com, Drug profile )
METABOLISM AND EXCRETION:
Site of metabolism:
Active metabolite:
Bis-digitoxonide and mono-digitoxonide
Half life:
40 hours
Route of excretion:
Excreted by Kidney (80%)
Stomach and Liver
(Katzung and druginfosys.com)
CLINICAL PHARMACOLOGY
Therapeutic/
pharmacology class
Mechanism of action
Cardiovascular
agents
Cardiac glycoside
Inotropic agent
Digoxin binds with Na-K-ATPase by inhibiting
Na-K-ATPase, digoxin increases intracellular
calcium, reduces catecholamine reuptake
and allow the efflux of potassium and thus
increase force and velocity of myocardial
contractions.
(Drug.com)
Indication / therapeutic
use
Adverse effect
Contraindications/
precaution
CHF
Heart failure
Supraventricular
tachycardia
Supraventricular
arrthymias
Atrial fibrillation.
Ventricular
tachycardia
Ventricular
fibrillation
Heart block
Increased FSH
Hyperkalemia
Dizziness
Nervousness
Anorexia
Heart block
Obstructive
cardiomyopathy
Wolf-Parkinson-
white syndrome
Acute myocarditis
Aortic valve disease
Constrictive
pericarditis.
(BNF, Druginfosys.com)
DOSAGE AND ADMINSTRATION
Sr.
no
Indication Route
of
admin
Recommended dosage form Duration of
therapy
Infants/neonates
Mg/Kg/day and
frequency
Child Adult
1
2
Heart failure
Atrial
fibrillation
Oral
(sol.)
PO
IV
135-138
mcg/kg/day
35-60Mcg/Kg
30-50 Mcg/kg
5.6-11.3
mcg/kg
body wt.
20-35
Mcg/kg
3-4.5
mcg/kg
body
wt.
0.5-0.75
g
0.4-
0.6g
per day
_
Sr.
no
Indication Route of
admin
Recommended dosage form Duration
of
therapy
Infants/neon
ates
Mg/Kg/day
and
frequency
Child Adult
3
4
Rapid
digitalizati
on with
loading
dose
If patients
are
switched
from
PO
IV
Oral
formulation
to IV or IM
Individualize
dose
Dose
reduced by
20-25%
Individualize
dose
Dose
reduced by
20-25%
0.5-0.75
g,
0.4-0.6 g
Dose
reduced
by 20-
25%
per day
_
(BNF and Drug.com)
Sr.
no
Indication Route
of
admin
Recommended dosage form Durati
on of
therap
y
Infants/neona
tes
Mg/Kg/day
and
frequency
Child Adult
5 Liver dose
adjustment
_ No
adjustment
No
adjustment
No
adjustmen
t
_
Drugs.com
Drug food
interaction
Could be
crushed N/Y
Direction for reconstruction
in case of suspension
Direction for use
No interaction
with alcohol
and
Tobacco
Food with high
fiber decrease
digoxin
absorption
No
No Continue to take
it even if you feel
well.
Take medication
every day at the
same time.
GUIDELINES
1. For oral route:
(Druginfosys.com and Drug.com)
2- For Iv route
Compatible IV
fluids
incompatibilities Storage time and
temp, after
reconstructions
5% dextrose,
normal saline,
additive
compatibilities:
calcium
gluconate,
heparin, kcl
Additive
incompatibilities;
Dopamine and
dobutamine
Store at 25C
Store in a dry
place and protect
from light.
Immediately use
diluted injection
(A to Z Drugs fact, Druginfosys.com)
DRUG-DRUG INTERACTIONS
verapamil
Mechanism of action:
Increase serum digoxin level
Pharmacist recommendations:
Avoid concurrent use of both drug
ANTACID,NEOMYCIN AND PHENYTOIN
Mechanism of action:
Decrease serum digoxin concentration.
Pharmacist recommendations:
Avoid concurrent use of both drugs.
(Reference: BNF and Rx list.com)
Therapeutic dose of digoxin may
cause prolongation of PR interval
and depression of ST segment in
ECG. It may produce false positive
changes on ECG.
DRUG-LAB INTERACTIONS:
(A to Z Drugs facts)
Toxic dose Sign and
symptoms
Lethal dose Management/
treatment
0.1 mg/kg Confusion
Loss of
appetite
vomiting,
diarrhea,
Anorexia
Hypokalemia
10-15 mg Discontinue the
drug.
Remove the
drug
Determine
serum digoxin
level
DIGIBEND for
life threatening
toxicity.(anti
dot)
TOXICOLOGY
(Rx list.com)
MOST SUITABLE BRAND
Lenoxin (Tablet) by GSK
75
65
59
57
29
ROLL NO.
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