What Is Digoxin? Uses, Dosage, and Side Effects

Digoxin, also known as digitalis, is a medication with a long history in treating heart conditions. If you have questions about heart health and want to receive free answers, WHAT.EDU.VN is here to help. Let’s explore what digoxin is, its uses, how it works, and what you need to know about its safety. Understanding this medication can empower you to make informed decisions about your health and treatment options. Discover the insights you need on heart failure, atrial fibrillation, and cardiac glycosides.

1. What Is Digoxin?

Digoxin is a cardiac glycoside derived from the Digitalis lanata plant, often used when other treatments are not effective. Approved by the FDA, it is primarily used for mild-to-moderate heart conditions, such as heart failure and chronic atrial fibrillation. Digoxin helps control ventricular response rates and improves cardiac output.

2. What Are the FDA-Approved Indications for Digoxin?

Digoxin has several FDA-approved uses:

Chronic Atrial Fibrillation: Helps control the heart rate in individuals with persistent atrial fibrillation.
Heart Failure: Manages symptoms of heart failure, especially in patients with reduced ejection fraction (less than or equal to 40%).
Symptomatic Management: Provides relief from the symptoms associated with heart failure.

According to the ACC/AHA guidelines, digoxin can be considered for patients with stage C heart failure who remain symptomatic despite other treatments.

3. What Are the Off-Label Uses of Digoxin?

While digoxin is mainly used for heart conditions, it has been used off-label for other purposes, though these uses are limited due to safety concerns:

Fetal Supraventricular Tachyarrhythmia: Used to treat rapid heart rates in fetuses.
Supraventricular Tachycardia: Can be used as a rate-control agent when traditional therapies fail.
Fetal Demise Induction: Historically used to induce fetal death before second-trimester abortions, but this is rare today due to efficacy and safety concerns.

4. How Does Digoxin Work?

Digoxin primarily works through two main mechanisms:

Positive Inotropic Effect: Enhances myocardial contraction, increasing the heart’s ability to pump blood.
AV Node Inhibition: Slows the heart rate by prolonging the AV node’s refractory period.

Digoxin also stimulates the parasympathetic nervous system, reducing the speed of electrical conduction through the AV node.

5. What Are the Pharmacokinetics of Digoxin?

Understanding how digoxin moves through the body is crucial for proper dosing:

Absorption:
- Oral bioavailability is about 75%.
- Absorption may decrease when taken with high-fiber foods.
- Certain gut flora can metabolize digoxin, reducing its absorption.
Distribution:
- Undergoes tissue distribution for 6-8 hours after administration.
- Extensively distributed in body tissues with a large volume of distribution (475–500 L).
- Crosses the blood-brain barrier and placenta.
- About 25% is protein-bound in plasma.
Metabolism:
- About 13% of a dose is metabolized in healthy individuals.
- Metabolites include dihydro-digoxin, polar glucuronides, and sulfate conjugates.
Excretion:
- Excreted by the kidneys in proportion to the glomerular filtration rate.
- Half-life ranges from 36 to 48 hours and may be prolonged in renal failure.

6. What Are the Available Dosage Forms and Strengths of Digoxin?

Digoxin is available in various forms and strengths:

Oral Solution: 0.05 mg/mL
Injectable Solution: 0.1 mg/mL and 0.25 mg/mL
Tablets: 0.0625 mg, 0.125 mg, 0.1875 mg, and 0.25 mg

7. How Is Digoxin Administered?

Intravenous (IV) Administration: Preferred for rapid digitalization.
Intramuscular Injections: Less common, limited to a maximum of 2 mL per injection site. Should be administered deep into the muscle.

Key Considerations for Administration

Obtain an ECG before administration.
Assess and normalize electrolyte levels, especially potassium.
Reevaluate treatment if bradycardia is detected.
Monitor plasma digoxin levels 6-12 hours after the last loading dose to confirm steady-state levels.

8. What Are the Adult Dosages for Digoxin?

Heart Failure: 0.125 to 0.25 mg/day, adjusted to achieve a target serum concentration of 0.5 to less than 0.9 ng/mL.
Atrial Fibrillation: Initial loading dose of 0.25 to 0.5 mg, with additional doses of 0.25 mg every 6 hours, not exceeding 1.5 mg in 24 hours. Maintenance dosage typically ranges from 0.0625 to 0.25 mg/day.

9. How Does Digoxin Dosage Differ in Specific Patient Populations?

Hepatic Impairment: Dosage adjustments are usually not required.
Renal Impairment: Reduced maintenance doses are necessary due to decreased clearance.
Pregnancy: Monitor neonates for toxicity following in-utero exposure. Dosage adjustments may be needed due to physiological changes during pregnancy.
Breastfeeding: Digoxin concentrations in breast milk are low, with minimal risk to the infant. Delay breastfeeding for at least 2 hours after IV administration.
Pediatric Patients: Dosing must be individualized, especially for newborns and premature infants.
Older Patients: Start with a low dosage of 0.125 mg/day or every other day, especially for those aged 70 or older, with impaired renal function, or low lean body mass.

10. What Are the Common Adverse Effects of Digoxin?

Digoxin toxicity can lead to fatal cardiac arrhythmias. The risk increases when serum concentrations exceed 2.0 ng/mL.

Common Adverse Effects

Nausea, vomiting, and anorexia
Visual disturbances (color changes like xanthopsia)
Blurry vision or photopsia
Proarrhythmic effects, leading to ventricular tachyarrhythmias
Rash, headache, and gynecomastia

11. What Are the Drug-Drug Interactions to Be Aware Of?

Several drugs can interact with digoxin, affecting its levels and increasing the risk of toxicity:

Azole Antifungals: Can increase digoxin levels by inhibiting P-glycoprotein.
Macrolide Antibiotics: Inhibit P-glycoprotein, increasing intestinal absorption of digoxin.
Class III Antiarrhythmic Drugs: Concomitant use with dofetilide can increase the risk of torsades de pointes.
Ibarbadine: Increases the risk of bradycardia when used concurrently with digoxin.
Quinidine: May significantly increase serum digoxin levels.
IV Calcium Products: Can induce severe arrhythmias in digitalized patients when administered rapidly via the IV route.

12. What Are the Contraindications for Digoxin Use?

Digoxin is contraindicated in certain conditions:

Acute myocardial infarction
Ventricular fibrillation
Hypersensitivity to the drug

13. What Warnings and Precautions Should Be Considered?

Acute myocardial infarction (increases myocardial oxygen demand)
Myocarditis
Hypomagnesemia
Hypokalemia
Wolf-Parkinson-White syndrome
Hypercalcemia or hypocalcemia
Renal impairment
Diseased SA node
Bradycardia
AV block
Restrictive cardiomyopathy
Hypothyroidism (delays digoxin clearance)

14. How Should Digoxin Therapy Be Monitored?

Digoxin has a narrow therapeutic index, with recommended serum levels ranging from 0.8 to 2 ng/mL. Blood should be drawn at least 6 to 8 hours after the last dose.

Monitoring Recommendations

Monitor levels, especially if there have been recent changes in medication.
Request regular ECGs and bloodwork to assess renal function and electrolyte levels.
Check digoxin levels 1 week after starting the medication and regularly afterward.
The ACC Foundation and AHA recommend digoxin plasma levels between 0.5 and 0.9 ng/mL for heart failure.

ECG Changes Associated with Digoxin

Downsloping ST-segment depression (reverse check sign)
Decreased QT interval
Prolonged PR interval
T wave inversion or flattening

15. What Are the Signs and Symptoms of Digoxin Overdose?

Common signs of digoxin toxicity include:

Nausea, vomiting, anorexia, and fatigue
Life-threatening arrhythmias or malignant hyperkalemia
Bradycardia
Neurological symptoms such as confusion and weakness
Visual disturbances like xanthopsia

Hyperkalemia is a significant marker of toxicity, while hypomagnesemia, hypokalemia, and hypercalcemia can increase susceptibility to digoxin’s effects.

16. How Is Digoxin Overdose Managed?

For life-threatening hyperkalemia, treatment should be initiated with glucose and insulin.
Activated charcoal may be administered in cases of acute overdose.
Ventricular arrhythmias can be treated with lidocaine or phenytoin.
Digoxin immune fab is the recommended reversal agent in the event of an overdose.

Conditions Indicating the Use of Digoxin Immune Fab

Any life-threatening digoxin-related dysrhythmia
Refractory hyperkalemia
Serum digoxin concentration greater than 15 ng/mL at any time or above 10 ng/mL 6 hours post-ingestion
Acute ingestion of 10 mg in adults
Acute ingestion of 4 mg in children
Chronic elevation of serum digoxin concentration with altered mental status, dysrhythmias, or severe gastrointestinal symptoms

17. How Can the Healthcare Team Enhance Outcomes in Digoxin Therapy?

Effective management of digoxin therapy requires an interprofessional healthcare team, including clinicians, specialists, nurses, and pharmacists. This team must collaborate to optimize therapy and prevent adverse effects.

Key Strategies for Enhanced Outcomes

Regularly review the patient’s medication profile for potential drug interactions.
Consider consultation with a nephrologist if emergent hemodialysis is indicated.
Provide supportive care, including IV hydration and electrolyte repletion.
Involve a toxicologist for specialized guidance.

18. FAQs about Digoxin

Question	Answer
What is the primary use of digoxin?	Digoxin is primarily used to treat heart failure and control heart rate in atrial fibrillation.
How does digoxin help with heart failure?	Digoxin increases the heart’s ability to pump blood and reduces symptoms like shortness of breath and swelling.
What are the common side effects of digoxin?	Common side effects include nausea, vomiting, visual disturbances, and irregular heartbeats.
How often should digoxin levels be checked?	Digoxin levels should be checked regularly, especially after starting the medication or changing the dose, and whenever symptoms suggest toxicity.
What should I do if I miss a dose of digoxin?	If you miss a dose, take it as soon as you remember. However, if it’s almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose.
Can I take digoxin with other medications?	It’s important to inform your doctor about all medications you are taking, as many drugs can interact with digoxin and increase the risk of side effects.
What should I avoid while taking digoxin?	Avoid taking digoxin with high-fiber foods, as they can reduce its absorption. Also, limit alcohol consumption, as it can worsen heart conditions.
How does renal impairment affect digoxin dosage?	Patients with renal impairment require lower doses of digoxin because their kidneys cannot eliminate the drug efficiently, increasing the risk of toxicity.
What are the signs of digoxin toxicity to watch out for?	Signs of digoxin toxicity include loss of appetite, nausea, vomiting, diarrhea, vision changes, confusion, and irregular heartbeats. Seek medical attention immediately if you experience these symptoms.
How does digoxin affect the elderly?	Elderly patients are more sensitive to digoxin’s effects and are at a higher risk of toxicity due to age-related changes in kidney function and metabolism. Lower doses are often recommended.
What is the relationship between digoxin and potassium levels in the body?	Low potassium levels (hypokalemia) can increase the risk of digoxin toxicity. Your doctor will monitor your potassium levels and may prescribe potassium supplements if needed.
What are some lifestyle changes to consider when taking digoxin?	Lifestyle changes such as a low-sodium diet, regular exercise, and avoiding smoking can help improve heart health and the effectiveness of digoxin.
How long does it take for digoxin to start working?	Digoxin usually starts to work within a few hours, but it may take several days to weeks to achieve its full therapeutic effect.
Is digoxin safe for pregnant women?	Digoxin can be used during pregnancy if necessary, but it should be used with caution and under close medical supervision due to its potential effects on the fetus.
Can digoxin cause any psychological side effects?	In rare cases, digoxin can cause psychological side effects such as confusion, delirium, and hallucinations, especially in older adults or those with kidney problems.
What is the cost of digoxin?	The cost of digoxin can vary depending on the brand, dosage, and location. It is generally an affordable medication, especially in its generic form.
What should I do before undergoing surgery while taking digoxin?	Before undergoing surgery, inform your surgeon and anesthesiologist that you are taking digoxin. They may need to adjust your dosage or monitor your heart function during and after the procedure.
Is there a natural alternative to digoxin?	There is no safe or effective natural alternative to digoxin. It is essential to follow your doctor’s prescribed treatment plan and not replace it with unproven remedies.
How does digoxin affect blood pressure?	Digoxin does not directly affect blood pressure, but it can improve heart function, which may indirectly help regulate blood pressure.
What is the interaction between digoxin and antacids?	Antacids can decrease the absorption of digoxin, so it’s best to take digoxin at least two hours before or after taking antacids to ensure proper absorption.

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