Drug NameDigoxin Drug UsesDigoxin is used for treating heart failure and slowing the heart rate in patients with chronic atrial fibrillation, a type of abnormal heart rhythm. It may also be used for certain conditions as determined by your doctor. How to useUse Digoxin as directed by your doctor.
- Take Digoxin by mouth with or without food.
Ask your health care provider any questions you may have about how to use Digoxin. Drug Class and MechanismDigoxin is a digitalis glycoside. It works by increasing the force of contraction of the heart and slowing the heart rate. Missed DoseTake the missed dose up to 12 hours late. If more than 12 hours have passed, skip the missed dose and take only the next regularly scheduled dose. Do Not take a double dose of this medication. Storage Store Digoxin between 68 and 77 degrees F (20 and 25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Digoxin out of the reach of children and away from pets. Possible Side EffectsCheck with your doctor if any of these most common side effects persist or become bothersome:
- constipation; dizziness or lightheadedness when sitting up or standing; excessive urination; headache; increased cough; nasal inflammation; nausea.
Seek medical attention right away if any of these severe side effects occur:
- severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; diarrhea; dry mouth or unusual thirst; hearing loss or ringing in the ears; loss of appetite; muscle pain or cramps; rapid or irregular heartbeat; rectal bleeding; restlessness; unusual tiredness or weakness; vomiting.
More InformationIf you have any questions about Digoxin, please talk with your doctor, pharmacist, or other health care provider.
Digoxin is to be used only by the patient for whom it is prescribed. Do not share it with other people. Warnings/PrecautionsDo not use Digoxin if:
- you are allergic to any ingredient in Digoxin or other digitalis medicines;
- you have Beriberi heart disease;
- you have certain types of heart rhythm problems, such as ventricular fibrillation.
Contact your doctor or health care provider right away if any of these apply to you.
What is digoxin?
Digoxin is derived from the leaves of a digitalis plant. Digoxin helps make the heart beat stronger and with a more regular rhythm.
Digoxin is used to treat congestive heart failure.
Digoxin is also used to treat atrial fibrillation, a heart rhythm disorder of the atria (the upper chambers of the heart that allow blood to flow into the heart).
Digoxin may also be used for other purposes not listed in this medication guide.
What is the most important information I should know about digoxin?
You should not use this medication if you are allergic to digoxin, or if you have ventricular fibrillation (a heart rhythm disorder of the ventricles, or lower chambers of the heart that allow blood to flow out of the heart).
Before using digoxin, tell your doctor if you have certain heart conditions, especially "AV block" (unless you have a pacemaker), or a recent history of heart attack. Also tell your doctor if you have kidney disease, a thyroid disorder, an electrolyte imbalance (such as low levels of calcium, potassium, or magnesium in your blood), or if you are malnourished or have recently been sick with vomiting or diarrhea.
Keep taking digoxin as directed, even if you feel well. Get your prescription refilled before you run out of medicine completely.
Do not stop taking digoxin without first talking to your doctor. Stopping suddenly may make your condition worse.
Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Digoxin overdose can occur more easily if you are dehydrated.
There are many other medicines that can interact with digoxin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.
What should I discuss with my healthcare provider before taking digoxin?
You should not use this medication if you are allergic to digoxin, or if you have ventricular fibrillation (a heart rhythm disorder of the ventricles, or lower chambers of the heart that allow blood to flow out of the heart).
If you have certain conditions, you may need a dose adjustment or special tests to safely use this medication. Before using digoxin, tell your doctor if you have:
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certain heart conditions, especially "AV block" (unless you have a pacemaker);
-
a recent history of heart attack;
- kidney disease;
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a thyroid disorder;
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an electrolyte imbalance (such as low levels of calcium, potassium, or magnesium in your blood); or
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if you are malnourished or have recently been sick with vomiting or diarrhea.
FDA pregnancy category C. Digoxin may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Digoxin can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Older adults may be more likely to have side effects from digoxin.
How should I take digoxin?
Take this medication exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label.
Take digoxin with a full glass of water.
Try to take the medication at the same time every day.
Measure liquid medicine with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.
To be sure this medication is not causing harmful effects, your blood may need to be tested on a regular basis. Your kidney function may also need to be tested. Do not miss any scheduled appointments.
Keep taking digoxin as directed, even if you feel well. Get your prescription refilled before you run out of medicine completely.
Do not stop taking digoxin without first talking to your doctor. Stopping suddenly may make your condition worse. Store this medication at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If your next dose is less than 12 hours away, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine.
Overdose symptoms may include nausea, vomiting, diarrhea, loss of appetite, blurred vision, seeing halos around lights or objects, severe skin rash, fast/slow or uneven heartbeats, and feeling like you might pass out.
What should I avoid while taking digoxin?
Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Digoxin overdose can occur more easily if you are dehydrated.
Digoxin side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:
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fast, slow, or uneven heart rate;
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bloody or black, tarry stools;
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blurred vision, yellowed vision; or
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confusion, hallucinations, unusual thoughts or behavior.
Less serious side effects may include:
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mild nausea, vomiting, diarrhea;
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feeling weak or dizzy;
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headache;
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enlarged breasts in men; or
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mild skin rash.
This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.
Digoxin Dosing Information
Usual Adult Dose for Congestive Heart Failure: Rapid Digitalization with a Loading Dose:
Peak digoxin body stores of 8 to 12 mcg/kg generally provide a therapeutic effect with minimum risk of toxicity in most patients with heart failure and normal sinus rhythm.
The loading dose should be administered in several fractions, with approximately half the total given as the first dose. Additional fractions of the total dose may be given at 6 to 8 hour intervals. Careful assessment of the patient's clinical response should be considered before each additional dose. If the patient's response necessitates a change from the calculated loading dose of digoxin, then calculation of the maintenance dose should be based upon the amount actually given.
Tablets:
Initial: 500 to 750 mcg usually produces a detectable effect in 0.5 to 2 hours with a maximal effect in 2 to 6 hours. Additional doses of 125 to 375 mcg may be given at 6 to 8 hour intervals until clinical evidence of an adequate effect is noted. The usual amount of digoxin tablets that a 70 kg patient requires to achieve 8 to 12 mcg/kg peak body stores is 750 to 1250 mcg.
Capsules:
Initial: 400 to 600 mcg of digoxin capsules generally produces a detectable effect in 0.5 to 2 hours with a maximal effect in 2 to 6 hours. Additional doses of 100 to 300 mcg may be given cautiously at 6 to 8 hour intervals until clinical evidence of an adequate effect is noted. The usual amount of digoxin capsules that a 70 kg patient requires to achieve 8 to 12 mcg/kg peak body stores is 600 to 1000 mcg.
Injection:
Initial: 400 to 600 mcg of digoxin intravenously usually produces a detectable effect in 5 to 30 minutes with a maximal effect in 1 to 4 hours. Additional doses of 100 to 300 mcg may be given cautiously at 6 to 8 hour intervals until clinical evidence of an adequate effect is noted. The usual amount of digoxin injection that a 70 kg patient requires to achieve 8 to 12 mcg/kg peak body stores is 600 to 1000 mcg. The injectable route is frequently used to achieve rapid digitalization, with conversion to digoxin tablets or digoxin capsules for maintenance therapy.
Maintenance Dose:
The doses of digoxin tablets used in controlled trials in patients with heart failure have ranged from 125 to 500 mcg once daily. In these studies, the digoxin dose has been generally titrated according to the patient's age, lean body weight, and renal function. Therapy is generally initiated at a dose of 250 mcg once daily in patients under age 70 with good renal function. Usual Adult Dose for Atrial Fibrillation: Peak digoxin body stores larger than the 8 to 12 mcg/kg required for most patients with heart failure and normal sinus rhythm have been used for control of ventricular rate in patients with atrial fibrillation. Doses of digoxin used for the treatment of chronic atrial fibrillation should be titrated to the minimum dose that achieves the desired ventricular rate control without causing undesirable side effects. Usual Geriatric Dose for not applicable: The recommended dosages of digoxin may require considerable modification in elderly patients. The dosage information provided below is based on a healthy adult patient with normal renal function.
Rapid Digitalization with a Loading Dose:
Peak digoxin body stores of 8 to 12 mcg/kg generally provide a therapeutic effect with minimum risk of toxicity in most patients with heart failure and normal sinus rhythm.
The loading dose should be administered in several fractions, with approximately half the total given as the first dose. Additional fractions of the total dose may be given at 6 to 8 hour intervals. Careful assessment of the patient's clinical response should be considered before each additional dose. If the patient's response necessitates a change from the calculated loading dose of digoxin, then calculation of the maintenance dose should be based upon the amount actually given.
Tablets:
Initial: 500 to 750 mcg usually produces a detectable effect in 0.5 to 2 hours with a maximal effect in 2 to 6 hours. Additional doses of 125 to 375 mcg may be given at 6 to 8 hour intervals until clinical evidence of an adequate effect is noted. The usual amount of digoxin tablets that a 70 kg patient requires to achieve 8 to 12 mcg/kg peak body stores is 750 to 1250 mcg.
Capsules:
Initial: 400 to 600 mcg of digoxin capsules generally produces a detectable effect in 0.5 to 2 hours with a maximal effect in 2 to 6 hours. Additional doses of 100 to 300 mcg may be given cautiously at 6 to 8 hour intervals until clinical evidence of an adequate effect is noted. The usual amount of digoxin capsules that a 70 kg patient requires to achieve 8 to 12 mcg/kg peak body stores is 600 to 1000 mcg.
Injection:
Initial: 400 to 600 mcg of digoxin intravenously usually produces a detectable effect in 5 to 30 minutes with a maximal effect in 1 to 4 hours. Additional doses of 100 to 300 mcg may be given cautiously at 6 to 8 hour intervals until clinical evidence of an adequate effect is noted. The usual amount of digoxin injection that a 70 kg patient requires to achieve 8 to 12 mcg/kg peak body stores is 600 to 1000 mcg. The injectable route is frequently used to achieve rapid digitalization, with conversion to digoxin tablets or digoxin capsules for maintenance therapy.
Maintenance Dose:
In general, a maintenance dose of 125 mcg orally once daily is recommended in patients over the age of 70. Doses may be increased every 2 weeks according to clinical response. Usual Pediatric Dose for not applicable: Administer loading doses in several portions, give roughly half the total as the first dose. Give additional fractions of the total dose at 6 to 8 hour intervals (oral) or 4 to 8 hour intervals (parenteral). Divided daily dosing is recommended for infants and young children under 10 years of age.
Parenteral administration should be used only when the need for rapid digitalization is urgent or when the drug cannot be taken orally. Intravenous administration is preferred over intramuscular injection as it can lead to severe pain at the injection site. If it is necessary to administer the drug by the intramuscular route, it should be injected deep into the muscle followed by massage. No more than 500 mcg should be injected into a single site.
Calculated doses should be based on lean body weight.
Premature:
Digitalizing (Loading) dose: Oral elixir: 20 to 30 mcg/kg; Intravenous: 15 to 25 mcg/kg
Maintenance dose: 20% to 30% of the loading dose
Full Term:
Digitalizing (Loading) dose: Oral elixir: 25 to 35 mcg/kg; Intravenous: 20 to 30 mcg/kg
Maintenance dose: 25% to 35% of the loading dose
1-24 months:
Digitalizing (Loading) dose: Oral elixir: 35 to 60 mcg/kg; Intravenous: 30 to 50 mcg/kg
Maintenance dose: 25% to 35% of the loading dose
2-5 years:
Digitalizing (Loading) dose: Oral elixir: 30 to 40 mcg/kg; Intravenous: 25 to 35 mcg/kg
Maintenance dose: 25% to 35% of the loading dose
5-10 years:
Digitalizing (Loading) dose: Oral elixir: 20 to 35 mcg/kg; Intravenous: 15 to 30 mcg/kg
Maintenance dose: 25% to 35% of the loading dose
> 10 years:
Digitalizing (Loading) dose: Oral elixir: 10 to 15 mcg/kg; Intravenous: 8 to 12 mcg/kg
Maintenance dose: 25% to 35% of the loading dose
What other drugs will affect digoxin?
Many drugs can interact with digoxin. Below is just a partial list. Tell your doctor if you are using:
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an antacid, or Kaopectate;
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alprazolam (Xanax);
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cancer medications;
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clonidine (Catapres);
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supplements or medications that contain calcium;
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a diuretic (water pill), such as spironolactone (Aldactone, Aldactazide);
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amphotericin B (Fungizone, AmBisome, Abelcet);
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cholestyramine (Questran, Prevalite);
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epinephrine (EpiPen);
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guanabenz (Wytensin) or guanfacine (Tenex);
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indomethacin (Indocin);
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isoproterenol (Isuprel);
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itraconazole (Sporanox);
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levothyroxine (Synthroid, Levothroid, and others);
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methyldopa (Aldomet);
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metoclopramide (Reglan);
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neomycin (Mycifradin, Neo-Fradin, Neo-Tab);
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rifampin (Rifadin, Rifater, Rifamate);
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sulfasalazine (Azulfidine); or
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an antibiotic such as erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), clarithromycin (Biaxin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap);
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a beta-blocker such as carvedilol (Coreg), metoprolol (Lopressor, Toprol), and others;
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a calcium channel blocker such as amlodipine (Norvasc), diltiazem (Tiazac, Cartia, Cardizem), felodipine (Plendil), nisoldipine (Sular), verapamil (Calan, Covera, Isoptin, Verelan), and others;
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decongestant cold or allergy medicine, or nasal sprays such as Afrin, Duramist, Neo-Synephrine, Tysine Nasal, and others;
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a heart rhythm medication such as amiodarone (Cordarone, Pacerone), propafenone (Rythmol), or quinidine (Quinaglute, Quinidex, Quin-Release); or
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steroids such as prednisone, fluticasone (Advair), mometasone (Asmanex, Nasonex), dexamethasone (Decadron, Hexadrol) and others.
This list is not complete and there are many other medicines that can interact with digoxin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.
Where can I get more information?
- Your pharmacist can provide more information about digoxin.
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