Digoxin

May be taken with or without food.

Ventricular tachycardia or fibrillation, arrhythmias caused by cardiac glycoside intoxication, supraventricular arrhythmias associated with an accessory atrioventricular pathway (e.g. Wolff-Parkinson-White syndrome); hypertrophic obstructive cardiomyopathy (unless there is concomitant atrial fibrillation and heart failure), intermittent complete heart block or 2nd-degree atrioventricular block (especially if there is a history of Stokes-Adams attacks), constrictive pericarditis (unless it is used to control the ventricular rate in atrial fibrillation or to improve systolic dysfunction).

Patient with arrhythmias, sinoatrial disorder (e.g. sick sinus syndrome), acute MI, cardiac amyloidosis, myocarditis, beriberi heart disease, severe respiratory disease, hypokalaemia, hypoxia, hypomagnesaemia, marked hypercalcaemia, thyroid disease, hypermetabolic states, malabsorption syndrome (e.g. chronic diarrhoea) or gastrointestinal reconstructions. Patients undergoing elective direct current cardioversion. Renal impairment. Children and elderly. Pregnancy and lactation. Patient Counselling This drug may cause CNS and visual disturbances, if affected, do not drive or operate machinery. Monitoring Parameters Assess serum electrolytes and renal function (serum creatinine concentration) at baseline and periodically. Obtain serum digoxin concentrations just before the next scheduled dose or ≥6 hours after the last dose. Monitor heart rate and rhythm along with periodic ECGs. Observe for signs and symptoms of digoxin toxicity, including noncardiac signs such as confusion and depression.

Significant: Arrhythmias, PR interval prolongation, depression of the ST segment on ECG. Blood and lymphatic system disorders: Thrombocytopenia. Cardiac disorders: Conduction disorder, bigeminy, trigeminy, sinus bradycardia. Eye disorders: Visual impairment (e.g. blurred vision, xanthopsia). Gastrointestinal disorders: Diarrhoea, nausea, vomiting, abdominal pain, intestinal ischaemia, gastrointestinal necrosis. General disorders and administration site conditions: Weakness. Nervous system disorders: Dizziness, headache. Psychiatric disorders: Apathy, confusion, mental disturbances (e.g. anxiety, depression, delirium, hallucinations). Reproductive system and breast disorders: Gynaecomastia. Skin and subcutaneous tissue disorders: Rash.
Potentially Fatal: Digoxin toxicity.

Increased effects with loop diuretics, hydrochlorothiazide, amiodarone, canagliflozin, daclatasvir, flibanserin, flecainide, prazosin, propafenone, quinidine, macrolide antibiotics (e.g. erythromycin, clarithromycin, gentamicin), isavuconazole, itraconazole, ivacaftor, quinine, trimethoprim, alprazolam, indometacin, propantheline, mirabegron, nefazodone, atorvastatin, ciclosporin, epoprostenol, vasopressin receptor antagonists (e.g. tolvaptan, conivaptan), carvedilol, ritonavir/ritonavir containing regimens, telaprevir, dronedarone, ranolazine, simeprevir, telmisartan, lapatinib, ticagrelor, vandetanib, velpatasvir, venetoclax and vemurafenib. Concomitant use of sennosides may be associated with a moderate increase in the risk of digoxin toxicity in heart failure patients. Increased risk of hyperkalaemia with suxamethonium. Increased concentrations with lapatinib, NSAIDs, COX-2 inhibitors, verapamil, felodipine, tiapamil, PPIs (e.g. omeprazole). Decreased effects with antacids, certain bulk laxatives, kaolin-pectin, acarbose, neomycin, penicillamine, rifampicin, some cytostatics, metoclopramide, sulfasalazine, epinephrine, salbutamol, colestyramine, phenytoin, bupropion and supplemental enteral nutrition.

Cardiac Drugs

C01AA05 - digoxin ; Belongs to the class of digitalis glycosides. Used in the treatment of heart failure.