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Digoxin

Medical and Pharmacy Editor:

Brand Name: Lanoxin

Generic Name: Digoxin

Drug Class: Antidysrhythmics, V; Inotropic Agents

What Is Digoxin and How Does It Work?

Digoxin is used to treat heart failure, usually along with other medications. It is also used to treat a certain type of irregular heartbeat (chronic atrial fibrillation). Treating heart failure may help maintain your ability to walk and exercise and may improve the strength of your heart. Treating an irregular heartbeat can decrease the risk for blood clots, an effect that may reduce your risk for a heart attack or stroke.

Digoxin belongs to a class of medications called cardiac glycosides. It works by affecting certain minerals (sodium and potassium) inside heart cells. This reduces strain on the heart and helps it maintain a normal, steady, and strong heartbeat.

Digoxin is available under the following different brand names: Lanoxin.

Dosage of Digoxin:

Adult and Pediatric Dosage Forms and Strengths

Oral solution

  • 0.05 mg/mL

Injectable solution

  • 0.1 mg/mL
  • 0.25 mg/mL

Tablet

  • 0.0625 mg (Lanoxin only) (adult only)
  • 0.125 mg
  • 0.1875 mg (Lanoxin only) (adult only)
  • 0.25 mg

Atrial Fibrillation

Rapid digitalizing (loading-dose) regimen

  • Intravenous (IV): 8-12 mcg/kg (0.008-0.012 mg/kg) total loading dose; administer 50% initially; then may cautiously give 1/4 the loading dose every 6-8 hours twice; perform careful assessment of clinical response and toxicity before each dose
  • Oral: 10-15 mcg/kg total loading dose; administer 50% initially; then may cautiously give 1/4 the loading dose every 6-8 hours twice; perform careful assessment of clinical response and toxicity before each dose

Maintenance

  • Oral: 3.4-5.1 mcg/kg/day or 0.125-0.5 mg/day orally; may increase dose every 2 weeks based on clinical response, serum drug levels, and toxicity
  • Intravenous/intramuscular (IV/IM): 0.1-0.4 mg once/day; IM route not preferred due to severe injection site reaction

Heart Failure

  • As per ACCF/AHA guidelines, a loading dose to initiate digoxin therapy in patients with heart failure is not necessary
  • 0.125-0.25 mg orally/IV once/day; higher doses including 0.375-0.5 mg/day rarely needed
  • Use lower end of dosing (0.125 mg/day) in patients with impaired renal function or low lean body mass

Heart Failure/Atrial Fibrillation, Pediatric

  • Use doses at the lower end of the spectrum when treating heart failure
  • Reduce dose by 20-25% when changing from oral formulation or intramuscular (IM) to intravenous (IV) therapy
  • Premature neonate
    • Oral: 1st loading dose, 10-15 mcg/kg; 2nd and 3rd loading doses, 5-7.5 mcg/kg every 6-8 hours for 2 doses; maintenance: 5-7.5 mcg/kg/day divided every 12 hours
    • Intravenous/intramuscular (IV/IM): 1st loading dose, 7.5-12.5 mcg/kg; 2nd and 3rd loading doses, 3.75-6.25 mcg/kg every 6-8 hours for 2 doses; maintenance: 4-6 mcg/kg/day divided every 12 hours
  • Full-term neonate
    • Oral: 1st loading dose, 12.5-17.5 mcg/kg; 2nd and 3rd loading doses, 6.25-8.75 mcg/kg every 6-8 hours for 2 doses; maintenance: 6-10 mcg/kg/day divided every 12 hours
    • IV/IM: 1st loading dose, 10-15 mcg/kg; 2nd and 3rd loading doses, 5-7.5 mcg/kg every 6-8 hours for 2 doses; maintenance: 5-8 mcg/kg/day divided every 12 hours
  • Infants and children 1-24 months
    • Oral: 1st loading dose, 17.5-30 mcg/kg; 2nd and 3rd loading doses, 8.75-15 mcg/kg every 6-8 hours for 2 doses; maintenance: 10-15 mcg/kg/day divided every 12 hours
    • IV/IM: 1st loading dose, 15-25 mcg/kg; 2nd and 3rd loading doses, 7.5-12.5 mcg/kg every 6-8 hours for 2 doses; maintenance: 7.5-12 mcg/kg/day divided every 12 hours
  • 2-5 years
    • Oral: 1st loading dose, 15-20 mcg/kg; 2nd and 3rd loading doses, 8.75-10 mcg/kg every 6-8 hours for 2 doses; maintenance: 7.5-10 mcg/kg/day divided every 12 hours
    • IV/IM: 1st loading dose, 12.5-17.5 mcg/kg; 2nd and 3rd loading doses, 6.25-8.75 mcg/kg every 6-8 hours for 2 doses; maintenance: 6-9 mcg/kg/day divided every 12 hours
  • 5-10 years
    • Oral: 1st loading dose, 10-17.5 mcg/kg; 2nd and 3rd loading doses, 5-8.75 mcg/kg every 6-8 hours for 2 doses; maintenance: 5-10 mcg/kg/day divided every 12 hours
    • IV/IM: 1st loading dose, 7.5-15 mcg/kg; 2nd and 3rd loading doses, 3.75-7.5 mcg/kg every 6-8 hours for 2 doses; maintenance: 4-8 mcg/kg/day divided every 12 hours
  • Older than 10 years and less than 100 kg
    • Oral: 1st loading dose, 5-7.5 mcg/kg; 2nd and 3rd loading doses, 2.5-3.75 mcg/kg every 6-8 hours for 2 doses; maintenance: 2.5-5 mcg/kg/day
    • IV/IM: 1st loading dose, 4-6 mcg/kg; 2nd and 3rd loading doses, 2-3 mcg/kg every 6-8 hours for 2 doses; maintenance: 2-3 mcg/kg/day

Dosing Modifications

  • Adjust maintenance dose by estimating renal clearance and measuring serum levels
  • In heart failure, higher dosages have no additional benefit and may increase toxicity; decreased renal clearance may lead to increased toxicity
  • In geriatric patients, use lean body weight to calculate dose
Medically Reviewed by a Doctor on 5/30/2017



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