Digoxin side effects Digoxin - instructions for use, indications, form of release, composition, side effects, analogues and price

Dosage form

Tablets 0.25 mg

Compound

One tablet contains

active substance- digoxin 0.25 mg,

Excipients: microcrystalline cellulose, lactose monohydrate, corn starch, calcium stearate.

Description

Tablets of a round form of white color with a biconvex surface.

Pharmacotherapeutic group

Drugs for the treatment of heart disease. cardiac glycosides. digitalis glycosides. Digoxin.

ATX code C01AA05

Pharmacological properties

Pharmacokinetics

When taken orally, the drug is rapidly and completely absorbed in the digestive tract. Bioavailability - 60-70%. Therapeutic concentration of Digoxin in the blood is reached after 1 hour. The maximum concentration is 1.5 hours after oral administration. The half-life is 34 - 51 hours and depends on the functional state of the kidneys and the age of the patient (in young patients - 36 hours, in elderly patients - 68 hours). About 80% of the drug is excreted from the body in the urine unchanged.

Pharmacodynamics

Digoxin is a cardiac glycoside from the leaves of woolly foxglove (Digitalis lanata Ehrh.). It has a positive inotropic effect, increases systolic and stroke volumes of the heart, lengthens the refractory period, slows down AV conduction and reduces heart rate. In patients with congestive heart failure, it causes an indirect vasodilator effect. It has a moderate diuretic effect, reduces shortness of breath, swelling. If therapeutic doses are exceeded or if the patient is hypersensitive to glycosides, it can cause increased myocardial excitability, which leads to cardiac arrhythmias.

The mechanism of action of digoxin on the heart is associated with inhibition of Na + -K + -ATPase activity, an increase in the level of catecholamines in the myocardium, inhibition of phosphodiesterase activity, and an increase in the content of cyclic adenosine monophosphate (cAMP) in cardiomyocytes.

Indications for use

Congestive heart failure

Atrial fibrillation and flutter (to regulate heart rate)

Supraventricular paroxysmal tachycardia

Dosage and administration

Tablets should be swallowed without chewing, drinking plenty of water. It is recommended to use between meals.

The dose of the drug is determined by the doctor individually.

Adults and children over 10 years old for rapid digitalization, use 0.5-1 mg (2-4 tablets), then every 6 hours, 0.25-0.75 mg for 2-3 days. After achieving a therapeutic effect, use in maintenance doses of 0.125 * -0.5 mg in 1-2 doses per day.

For slow digitalization, treatment should be started immediately with maintenance doses of 0.125 * -0.5 mg per day for 1-2 doses. Saturation occurs approximately 1 week after the start of therapy. The maximum daily dose for adults is 1.5 mg (6 tablets).

The maximum daily saturation dose is 0.75-1.5 mg, the maximum daily maintenance dose is 0.125*-0.5 mg.

*If it is necessary to use digoxin at a dose of 0.125 mg, the drug should be used with the possibility of such dosing.

Patients with impairediyami functionsandkidney Digoxin doses need to be reduced as the main route of elimination is via the kidneys.

Elderly patients age, given the age-related decline in kidney function and low muscle mass, it is necessary to carefully select doses to prevent the development of toxic reactions and overdose.

Side effects

Eosinophilia, thrombocytopenia, agranulocytosis

Hypersensitivity reactions, including itching, flushing, rash, incl. erythematous, papular, maculopapular, vesicular; urticaria, angioedema

Digoxin has estrogenic activity, so gynecomastia is possible in men with prolonged use

Disorientation, confusion, amnesia, depression, possible acute psychosis, delirium, visual and auditory hallucinations, especially in elderly patients, cases of seizures have been reported

Headache, neuralgia, fatigue, weakness, dizziness, drowsiness, bad dreams, anxiety, nervousness, agitation, apathy

Blurred vision, photophobia, halo effect, impaired visual perception (perception of surrounding objects in yellow, less often in green, red, blue, brown or white)

Rhythm and conduction disorders (sinus bradycardia, sinoatrial block, monofocal or multifocal extrasystole (especially bigeminy, trigeminy), PR interval prolongation, ST segment depression, AV block, paroxysmal atrial tachycardia, ventricular fibrillation, ventricular arrhythmias), occurrence or worsening of heart failure . These abnormalities may be early signs of excessive doses of digoxin.

Anorexia, nausea, vomiting, abdominal pain, diarrhea, especially in elderly patients; reported violation of visceral circulation, ischemia and necrosis of the intestine

Adverse reactions of digoxin are dose-dependent and usually develop at doses in excess of those necessary to achieve a therapeutic effect. Doses of the drug should be carefully selected and adjusted depending on the clinical condition of the patient.

Contraindications

Hypersensitivity to digoxin, auxiliary components of the drug, other cardiac glycosides

Intoxication with digitalis preparations previously used

History of arrhythmias caused by glycoside intoxication

Severe sinus bradycardia, II-III degree AV blockade, Adams-Stokes-Morgagni syndrome

carotid sinus syndrome

Hypertrophic obstructive cardiomyopathy

Supraventricular arrhythmias associated with additional atrioventricular conduction pathways, incl. Wolff-Parkinson-White syndrome

Ventricular paroxysmal tachycardia/ventricular fibrillation

Thoracic aortic aneurysm

Hypertrophic subaortic stenosis

Isolated mitral stenosis

Endocarditis, myocarditis, unstable angina, acute myocardial infarction, constrictive pericarditis, cardiac tamponade

Hypercalcemia, hypokalemia

Children's them adolescence up to 18 years

Drug Interactions

Digoxin is a substrate for P-glycoprotein. Drugs that induce or inhibit P-glycoprotein affect the pharmacokinetics of digoxin (the level of absorption in the digestive tract, renal clearance), changing its concentration in the blood.

Pharmacokinetic interactions

Preparations, increasing > 50 %

Amiodarone, dronedarone, flecainide, disopyramide, propafenone, quinidine, quinine, captopril, prazosin, nitrendipine, ranolazine, ritonavir, verapamil, felodipine, thiapamil- the dose of digoxin should be reduced with their simultaneous use by 30-50%, while continuing to monitor the level of digoxin in the blood plasma.

Preparations, increasing blood concentration of digoxin < 50 %

Carvedilol, diltiazem, nifedipine, nicardipine, lercanidipine, rabeprazole, telmisartan- Serum digoxin concentrations should be measured before concomitant therapy. Reduce digoxin dose by approximately 15-30% and continue monitoring.

Preparations, increasing blood concentration of digoxin (value unclear)

Alprazolam, diazepam, atorvastatin, azithromycin, clarithromycin, erythromycin, telithromycin, gentamicin, chloroquine, hydroxychloroquine, trimethoprim, cyclosporine, diclofenac, indomethacin, aspirin, ibuprofen, diphenoxylate, epoprostenol, esomeprazole, itraconazole, ketoconazole, lansoprazole, metformin, omeprazole, propaneline, nefazodon, trazodone, topiramate, spironolactone, tetracycline- measurement of serum digoxin concentrations before the use of concomitant drugs. If necessary, reduce the dose of digoxin and continue monitoring.

Preparations, reducing blood concentration of digoxin

Acarbose, adrenaline (epinephrine),Activated carbon, antacids, some cytostatics, cholestyramine, colestipol, exenatide, kaolin-pectin,some laxatives, nitroprusside, hydralazine, metoclopramide, miglitol, neomycin, penicillamine, carbimazole, rifampicin, salbutamol, sucralfate, sulfasalazine, phenytoin, barbiturates, phenylbutazone,high content food bran, St. John's wort preparations- measurement of serum digoxin concentrations before the use of concomitant drugs. Increase the dose of digoxin if necessary by 20-40% and continue monitoring.

Farmacodynamic interactions

Amphotericin, lithium salts, acetazolamide, loop and thiazide diuretics: hypokalemia caused by these drugs may increase the cardiotoxicity of digoxin and the risk of arrhythmias. If necessary, potassium preparations should be prescribed, electrolyte imbalance should be corrected. With the simultaneous use of diuretics with cardiac glycosides, the optimal dosage should be followed. You can periodically prescribe potassium-sparing diuretics (spironolactone, triamterene), which eliminate hypokalemia and arrhythmia. However, hyponatremia may develop.

Preparations potassium. Under the influence of potassium preparations, the undesirable effects of cardiac glycosides are reduced.

Corticosteroids, drugs corticotropin, carbenoxolone cause loss of potassium, retention of sodium and fluid in the body. As a result, the toxicity of digoxin increases, the risk of developing arrhythmias and heart failure. The condition of patients taking long-term courses of corticosteroids should be carefully monitored.

Calcium preparations, especially when administered rapidly intravenously, can lead to serious arrhythmias in digitalized patients.

Vitamin D and its analogues ( For example, ergocalciferol), teriparatide may increase the toxicity of digoxin due to an increase in the concentration of calcium in the blood plasma.

dofetilide: the risk of arrhythmia of the "torsades de pointes" type increases.

Moracizin: possible additional effects on cardiac conduction, a significant prolongation of the QT interval, which can lead to AV blockade.

Adrenomimetic agents: epinephrine (epinephrine), norepinephrine, dopamine, selective β2 receptor agonists, including salbutamol may increase the risk of developing arrhythmias.

Muscle relaxants (edrophonium, suxamethonium, pancuronium, tizanidine): it is possible to increase arterial hypotension, excessive bradycardia and atrioventricular blockade due to the rapid removal of potassium from myocardial cells. Simultaneous use should be avoided.

Beta blockers, incl. sotalol,and calcium channel blockers: increases the risk of proarrhythmic events, an additive effect on the conduction of the AV node can lead to bradycardia and complete heart block.

Phenytoin: Phenytoin administration should not be used to treat digoxin-induced arrhythmias due to the risk of cardiac arrest.

Colchicine: may increase the risk of developing myopathy.

Mefloquine: may increase the risk of developing bradycardia.

xanthine derivatives: preparations of caffeine or theophylline sometimes contribute to the occurrence of arrhythmias.

Aminazine and other phenothiazine derivatives: the action of cardiac glycosides decreases.

Anticholinesterase drugs: increased bradycardia. If necessary, it can be eliminated or weakened by the introduction of atropine sulfate.

Sodium adenosine triphosphate: should not be used simultaneously with cardiac glycosides in high doses, as the risk of adverse reactions from the cardiovascular system increases.

Etoricoxib, ketoprofen, meloxicam, piroxicam, and rofecoxib do not increase the level of digoxin in the blood plasma.

Ethylenediaminetetraacetic disodium acid salt: there is a decrease in the effectiveness and toxicity of cardiac glycosides.

Narcotic analgesics: the combination of fentanyl and cardiac glycosides can cause arterial hypotension.

Naproxen: as a member of the NSAID class, it can increase the concentration of cardiac glycosides in the blood plasma, and it is also possible to exacerbate heart failure and reduce kidney function.

Paracetamol: the clinical significance of this interaction has not been sufficiently studied, but there is evidence of a decrease in the excretion of cardiac glycosides by the kidneys under the influence of paracetamol.

special instructions

When treating with digoxin, the patient should be under medical supervision. With long-term therapy, the optimal individual dose of the drug is usually selected within 7-10 days.

In cases where the patient has taken other cardiac glycosides in the previous two weeks, it is recommended to start treatment with digoxin at lower doses. If necessary, the use of strophanthin should be prescribed no earlier than 24 hours after the abolition of digoxin.

The drug should be used with extreme caution:

Elderly patients - the trend towards decreased renal function and low muscle mass in the elderly affects the pharmacokinetics of digoxin: higher serum levels of digoxin, prolongation of the half-life, therefore there is an increased risk of adverse reactions, cumulative effect and the likelihood of overdose;

Debilitated patients, patients with impaired renal function, patients with an implanted pacemaker, as they may experience toxic effects at doses that are usually well tolerated by other patients;

With concomitant atrial fibrillation and heart failure;

Patients with thyroid disease - with reduced thyroid function, the initial and maintenance doses of digoxin should be reduced; in hyperthyroidism, there is relative resistance to digoxin, as a result of which the doses of the drug can be increased. When conducting a course of treatment for thyrotoxicosis, the doses of digoxin should be reduced when thyrotoxicosis is transferred to a controlled state. Alterations in thyroid function may affect sensitivity to digoxin regardless of its plasma concentration;

Patients with short bowel syndrome or malabsorption syndrome - due to impaired absorption of digoxin, higher doses of the drug may be required;

Patients with severe respiratory diseases - increased sensitivity of the myocardium to digitalis glycosides is possible;

Patients with cardiovascular disease in beriberi disease may have an inadequate response to digoxin if the underlying thiamine deficiency is not simultaneously treated;

With hypokalemia, hypomagnesemia, hypercalcemia, hypernatremia, hypothyroidism, hypoxia, "pulmonary" heart - the risk of digitalis intoxication, arrhythmias increases. Electrolyte imbalance needs to be corrected. Such patients should avoid the use of digoxin in high single doses.

Patients who are scheduled for cardioversion should stop taking digoxin 1-2 days before the procedure, if possible. If cardioversion is mandatory and digoxin has already been given, it is advisable to use the minimum effective shock.

During the period of treatment with digoxin, ECG, kidney function (serum creatinine concentration), electrolyte concentrations (potassium, calcium, magnesium) in blood serum should be regularly monitored.

Since digoxin slows sinoatrial and atrioventricular conduction, the use of therapeutic doses of digoxin can cause prolongation of the PR interval and depression of the ST segment on the electrocardiogram.

Digoxin may cause false positive ST-T wave changes on the ECG during exercise testing. These electrophysiological effects reflect the expected effect of the drug and do not indicate its toxicity.

During treatment, you should limit the use of indigestible foods, and foods containing pectins.

Digoxin tablets contain lactose. Patients with rare hereditary problems of galactose intolerance, lactase deficiency or glucose-galactose malabsorption syndrome should not take the drug.

Use during pregnancy or lactationIheapsbYu.

There is no information on the possibility of a teratogenic effect of digoxin. It should be borne in mind that digoxin crosses the placenta and the clearance of the drug during pregnancy increases.

During pregnancy, the drug can be used under medical supervision only when the expected benefit to the mother outweighs the potential risk to the fetus.

Digoxin passes into breast milk in amounts that do not have a negative effect on the child (the concentration of digoxin in breast milk is 0.6-0.9% of the concentration in the mother's blood plasma). When using digoxin during breastfeeding, the heart rate of the child should be monitored.

Features of the influence of the drug on the ability to drive a vehicle or potentially dangerous mechanisms

Until the individual reaction to the drug is clarified, it is necessary to refrain from driving vehicles and working with other mechanisms due to the possibility of adverse reactions from the nervous system and organs of vision.

Overdose

Overdose develops gradually, over several hours.

Symptoms: from the side of cardio-vascular system- arrhythmias, including bradycardia, atrioventricular block, ventricular tachycardia or extrasystole, ventricular fibrillation;

from the digestive tract- anorexia, nausea, vomiting, diarrhea;

from the central nervous systems and bodies feelings- headache, fatigue, dizziness, rarely - impaired color perception, decreased visual acuity, scotoma, macro- and micropsia, very rarely - confusion, syncope.

Dangerous symptoms are rhythm disturbances due to the risk of death in the development of ventricular arrhythmias or heart block with asystole.

Treatment: gastric lavage, activated charcoal, colestipol or cholestyramine. If an arrhythmia occurs, intravenously inject 2-2.4 g of potassium chloride with 10 IU of insulin in 500 ml of 5% glucose solution intravenously (stop the administration when the concentration of potassium in the blood serum is within 4-5.5 mmol / l). Means containing potassium are contraindicated in violation of atrioventricular conduction. With severe bradycardia, prescribe a solution of atropine sulfate. Shown oxygen therapy. Unithiol, ethylenediaminetetraacetate are also prescribed as a detoxifying agent. Therapy is symptomatic.

In case of hypokalemia in the absence of complete heart block, potassium preparations should be administered. With complete heart block, conduct pacing. With arrhythmias, lidocaine, procainamide, phenytoin, propranolol are used.

With a life-threatening overdose of digoxin, the introduction of sheep antibody fragments that bind digoxin through a membrane filter is indicated ( Digoxin immune fab, Digitalis- Antidote BM), 40 mg of the antidote binds approximately 0.6 mg of digoxin.

With an overdose of digoxin, dialysis and exchange transfusion are ineffective.

Release form and packaging

20 tablets in a blister pack. 2 blister packs, together with instructions for medical use in the state and Russian languages, are placed in a cardboard pack.

Ukraine, 03134, Kyiv, st. Mira, 17.

Cardiotonic drug, cardiac glycoside is Digoxin. Instructions for use informs that tablets of 0.1 mg and 0.25 mg, injections in ampoules for injection in solution are prescribed for cardiac pathologies.

Release form and composition

The drug is produced in the form of a solution for injection and in tablet form.

• 1 tablet contains 0.25 mg of the active ingredient digoxin.
• Tablets for children 0.1 mg.
• 1 ml of the solution contains the active substance in the amount of 0.25 mg.

Additional elements are: glycerin, ethanol, sodium phosphate, citric acid, injection water.

pharmachologic effect

Digoxin is characterized by vasodilating, moderate diuretic and inotropic (changes the force of contraction of the heart) effects. The use of Digoxin contributes to:

• Decreased atrioventricular conduction and heart rate.
• Increasing the refractory period.
• Increase in systolic and stroke volume of the heart.

In the case of cardiovascular insufficiency, this agent has a pronounced vasodilating effect. Its use reduces the severity of edema and shortness of breath, and also has a mild diuretic effect.

Indications for use

What helps Digoxin? Tablets are prescribed if the patient has:

• Atrial fibrillation and flutter of a chronic and paroxysmal course in a tachysystolic form, especially with concomitant chronic heart failure.
• Chronic heart failure II (with clinical manifestations) and III-IV functional class according to the NYHA classification - as part of complex therapy.

Solution for intravenous administration

• Paroxysmal supraventricular arrhythmias (atrial flutter, atrial fibrillation, supraventricular tachycardia).
• Chronic heart failure with atherosclerotic cardiosclerosis, decompensated valvular heart disease, myocardial overload in arterial hypertension, especially with a constant form of atrial flutter or tachysystolic atrial fibrillation.

Instructions for use

Digoxin tablets are taken orally. As with all cardiac glycosides, the dose should be selected with caution, individually for each patient. If the patient before the appointment of digoxin took cardiac glycosides, in this case, the dose of the drug must be reduced.

Adults and children over 10 years old

The dose of Digoxin depends on the need to quickly achieve a therapeutic effect.

Moderately fast digitalization (24-36 h)

Used in emergencies. The daily dose is 0.75-1.25 mg, divided into 2 doses, under ECG control before each subsequent dose. After reaching saturation, they switch to maintenance treatment.

Slow digitalization (5-7 days)

A daily dose of 0.125-0.5 mg is prescribed once a day for 5-7 days (until saturation is reached), after which they switch to maintenance treatment.

Chronic heart failure

In patients with chronic heart failure, Digoxin should be used in small doses: up to 0.25 mg per day (for patients weighing more than 85 kg, up to 0.375 mg per day). In elderly patients, the daily dose of digoxin should be reduced to 0.0625-0.0125 mg (1/4; 1/2 tablets).

Supportive care

The daily dose for maintenance therapy is set individually and is 0.125-0.75 mg. Maintenance therapy is usually carried out for a long time.

Children aged 3 to 10 years

The loading dose for children is 0.05-0.08 mg/kg per day; this dose is prescribed for 3-5 days with moderately rapid digitalization or for 6-7 days with slow digitalization. The maintenance dose for children is 0.01-0.025 mg / kg per day.

Solution for intravenous administration

The drug is administered in/in drip or jet. The doctor prescribes dosing individually, based on clinical indications. Recommended dosage:

Slow digitalization: up to 0.5 mg per day (in 1-2 doses).

Paroxysmal supraventricular arrhythmia: daily dose - 0.25-1 mg (in / in drip or jet).

Moderately rapid digitalization - intravenously at 0.25 mg 3 times a day (after which the patient is transferred to maintenance therapy - intravenously 0.125-0.25 mg 1 time per day).

A saturating dose for children is 0.05-0.08 mg per 1 kg of weight per day, with moderately fast digitalization it is administered for 3-5 days, with slow digitalization - 6-7 days.

The maintenance dose for children is 0.01-0.025 mg per 1 kg of the child's weight per day.

Contraindications

Heart failure of the diastolic type (with cardiac tamponade, with constrictive pericarditis, with amyloidosis of the heart, with cardiomyopathy) is also a contraindication to the appointment of Digoxin.

Direct contraindications for prescribing the drug are signs of glycoside intoxication, hypersensitivity to digoxin, Wolff-Parkinson-White syndrome, second-degree atrioventricular block and complete atrioventricular block, bradycardia.

The drug is contraindicated in isolated mitral stenosis.

You can not prescribe a medication for such manifestations of coronary heart disease as unstable angina and an acute period of myocardial infarction.

Severe dilatation of the heart, obesity, failure of the kidneys and hepatic parenchyma, inflammation of the myocardium, hypertrophy of the interventricular septum, subaortic stenosis, ventricular tachyarrhythmias - in these conditions, the use of the drug is unacceptable.

Side effects

Digoxin is a toxic compound, when the permissible dose is exceeded, glycoside intoxication (poisoning) of the body develops with side effects from various organs and systems:

• Digestive system - nausea, anorexia (complete lack of appetite), vomiting, diarrhea (diarrhea), abdominal pain, necrosis (death) of the small or large intestine.
• Allergic reactions - a rash on the skin, itching, less often urticaria may develop (a characteristic rash and swelling that looks like a nettle burn).
• Cases of the development of gynecomastia (an increase in the mammary glands according to the female type) in men, hypokalemia (a decrease in the level of potassium ions in the blood) are described. In case of development of manifestations of side effects, the drug is stopped.
• Sense organs - the appearance of "flies" before the eyes, the coloring of visible objects in a yellow-green color, a decrease in visual acuity.
• Nervous system - headache, sleep disturbances, dizziness, neuritis (inflammation of a peripheral nerve of various localization), sciatica (inflammation of the roots of the spinal cord), manic-depressive syndrome, paresthesia (impaired sensitivity of a skin area), impaired consciousness (fainting). Rarely, older people may develop disorientation in time and space, changes in consciousness, the appearance of one-color visual hallucinations.
• Blood and red bone marrow - a violation of the coagulation system with the development of chiseled hemorrhages in the skin (petechiae), nosebleeds and thrombocytopenic purpura.
• Cardiovascular system - paroxysmal ventricular tachycardia (increased heart rate), ventricular extrasystole (appearance of extraordinary ventricular contractions), nodal tachycardia, sinus bradycardia (decrease in heart rate), blockade of the fibers of the atrial conduction system or atrioventricular (atrioventricular) node, flickering or atrial flutter.

Children, during pregnancy and lactation

Digoxin is able to penetrate the hematoplacental barrier, as well as to concentrate in the blood plasma of the fetus. The active substance of the drug is excreted to a small extent with breast milk, therefore, during use by a nursing mother, it is necessary to constantly monitor the heart rate of the child.

Thus, indications for Digoxin for pregnant women are strictly limited, it can be prescribed to them only in the case when the potential effect for the mother outweighs the risk of violations in the fetus.

The drug is contraindicated in children under 3 years of age.

special instructions

The patient must follow the following instructions exactly:

• Use the drug only as prescribed by the doctor, do not change the dose yourself.
• Every day, use the drug only at the appointed time.
• If the heart rate is below 60 beats / min, you should immediately consult a doctor.
• If the next dose of the drug is missed, it should be taken immediately, when possible.
• Do not increase or double the dose.
• If the patient has not taken the drug for more than 2 days, this should be reported to the doctor.
• Before stopping the use of the drug, it is necessary to inform the doctor about it. If you experience vomiting, nausea, diarrhea, rapid heart rate, you should immediately consult a doctor.

drug interaction

The medicine can not be combined with alkalis, acids, salts of heavy metals and tannins. When used together with diuretics, insulin, calcium salt preparations, sympathomimetics, glucocorticosteroids, the risk of symptoms of glycoside intoxication increases.

In combination with quinidine, amiodarone and erythromycin, an increase in the content of digoxin in the blood is noted. Quinidine inhibits the excretion of the active substance.

The calcium channel blocker Verapamil reduces the rate of elimination of digoxin from the body by the kidneys, which leads to an increase in the concentration of cardiac glycoside. This effect of verapamil is gradually leveled off with long-term co-administration of drugs (more than six weeks).

Digoxin's analogs

According to the structure, analogues are determined:

1. Novodigal.
2. Digoxin Grindeks (TFT).

Holiday conditions and price

The average cost of Digoxin (tablets 0.25 mg No. 30) in Moscow is 38 rubles. Released by prescription.

The shelf life of the tablets is 3 years from the date of their manufacture. The drug must be stored in a dark, dry place at an air temperature ranging from +15 to +25C. Keep away from children.

Post Views: 295

The most famous cardiac glycosides(Cr) - digoxin and digitoxin. Digoxin is the only glycoside whose effect has been studied in placebo-controlled studies, so it is unreasonable to prescribe other CGs to patients with CHF. Digoxin acts by inhibiting the Na + / K-ATPase pump in the cell membrane, incl. Na+/K-ATPase pump of cardiac myocyte sarcolemma.

inhibition Na + / K-ATPase pump leads to an increase in intracellular calcium concentration and an increase in cardiac contractility, which confirms the secondary positive effects of digoxin in relation to its inotropic properties. However, in patients with HF, digoxin is likely to sensitize Na+/K-ATPase activity in the vagal afferent nerves and lead to increased vagal tone, which counteracts the increased adrenergic activation in severe HF.

Digoxin also inhibits the activity of Na + / K-ATPase in the kidneys and, therefore, reduces the resorption of sodium in the renal tubules. Treatment with digoxin is usually initiated at a dose of 0.125-0.25 mg/day (most patients should take 0.125 mg/day). Serum digoxin levels should be< 1,0 нг/мл, особенно у пожилых, у пациентов с ухудшением функции почек, а также с низкой массой тела, лишенной жира. Более высокие дозировки (0,375-0,50 мг/сут) для лечения СН применяют редко.

Clinicians have been using cardiac glycosides to treat patients with heart failure for over 200 years, but there is still controversy regarding their effectiveness. Since small and medium-sized studies carried out in the 1970s and 1980s gave mixed results, in the early 1990s two relatively large studies of the consequences of digoxin withdrawal were conducted: RADIANCE (Randomised Assessment of Digoxin on Inhibitors of the Angiotensin-Converting En-zyme) and PROVED (Prospective Randlmized Study of Ventricular Failure and the Efficacy of Digoxin ), which provided strong evidence for the clinical efficacy of digoxin.

During these research it was found that the progression of heart failure and hospitalization of patients with heart failure were more common in patients who stopped taking digoxin. And because the study of the consequences of drug withdrawal is difficult to consider in terms of the effectiveness of these drugs, the DIG study (Digitalis Investigation Group Trial) was prospectively aimed at studying the role of digitalis in the treatment of HF. This study showed that digoxin had no effect on mortality and hospitalizations, but as HF progressed, hospitalizations decreased and mortality rates improved. The DIG data showed a steady trend (p = 0.06) towards a decrease in the number of deaths due to progressive cardiac insufficiency, which was balanced by an increase in the number of SCD and deaths not due to cardiac insufficiency (p = 0.04).

One of the most important DIG results there was a direct dependence of mortality rates on the level of digoxin in the patient's blood serum. In male participants, digoxin levels of 0.6-0.8 ng/mL were associated with a reduction in mortality rates, so a minimum digoxin level of 0.5-1.0 ng/mL should be maintained. There is evidence that digoxin may be potentially harmful to women. Post hoc multivariate DIG analysis found that digoxin had a significantly greater (23%) risk of OS in women, possibly due to relatively lower BW in women who were dosed with digoxin based on a nomogram rather than trough levels. .

Digoxin (Digoxin), instructions for use

International name. Digoxin.

Composition and form of release. The active substance is digoxin. Tablets 0.0625, 0.125 and 0.25 mg. Solution for oral administration (1 ml-0.5 mg) 20 ml in vials. Solution (1 ml-0.25 mg) 1.0 and 2.0 ml in ampoules.

Pharmachologic effect. Cardiac glycoside contained in the leaves of woolly foxglove. Increases the strength and speed of heart contractions, slows down heart rate, slows down AV conduction. In patients with chronic heart failure, it causes an indirect vasodilating effect. It has a moderate diuretic effect. If therapeutic doses are exceeded or if the patient is hypersensitive to glycosides, it can cause an increase in myocardial excitability, which leads to cardiac arrhythmias.

Indications for taking digoxin. Chronic heart failure with decompensated valvular heart disease, atherosclerotic cardiosclerosis, myocardial overload in arterial hypertension, especially in the presence of a permanent form of tachysystolic atrial fibrillation or atrial flutter. Paroxysmal supraventricular arrhythmias (atrial fibrillation, atrial flutter, supraventricular tachycardia).

Dosing regimen. Set individually. With moderately rapid digitalization, 0.25 mg 4 times a day or 0.5 mg 2 times a day are prescribed orally. With intravenous administration, a daily dose of digoxin 0.75 mg in 3 injections is required. Digitalization is achieved on average in 2-3 days. Then the patient is transferred to a maintenance dose, which is 0.25-0.5 mg / day when the drug is administered orally and 0.125-0.25 mg when administered intravenously. With slow digitalization, treatment is immediately started with a maintenance dose (0.25-0.5 mg per day in 1 or 2 doses). Digitalization in this case occurs within a week in most patients. Patients with hypersensitivity to cardiac glycosides are prescribed smaller doses and digitalization is carried out at a slow pace. In case of paroxysmal supraventricular arrhythmias, 1-4 ml of a 0.025% digoxin solution (0.25-1.0 g) in 10-20 ml of a 20% glucose solution is injected intravenously. For intravenous drip, the same dose of digoxin is diluted in 100-200 ml of 5% glucose solution or 0.9% sodium chloride solution. The loading dose of digoxin for children is 0.05-0.08 mg/kg body weight; this dose is administered over 3-5 days with moderately rapid digitalization or within 6-7 days with slow digitalization. The maintenance dose of digoxin for children is 0.01-0.025 mg/kg per day. If the excretory function of the kidneys is impaired, it is necessary to reduce the dose of digoxin: with a creatinine clearance (CC) of 50-80 ml / min, the average maintenance dose is 50% of the average maintenance dose for individuals with normal renal function; with CC less than 10 ml / min -25% of the usual dose.

Side effects. Bradycardia, AV block, cardiac arrhythmias, anorexia, nausea, vomiting, diarrhea, headache, fatigue, dizziness. Rarely - staining of surrounding objects in green and yellow, flashing "flies" before the eyes, decreased visual acuity, scotomas, macro- and micropsia. In very rare cases, confusion, depression, insomnia, euphoria, delirious state, syncope, thrombosis of mesenteric vessels are possible. With prolonged use of digoxin, gynecomastia may develop.

Contraindications for the use of digoxin. Glycoside intoxication (absolute contraindication). Relative contraindications - severe bradycardia, AV blockade of 1 and 2 degrees, isolated mitral stenosis, hypertrophic subaortic stenosis, acute myocardial infarction, unstable angina pectoris, Wolff-Parkinson-White syndrome, cardiac tamponade, extrasystole, ventricular tachycardia.

Special instructions. The likelihood of digitalis intoxication increases with hypokalemia, hypomagnesemia, hypercalcemia, hypernatremia, hypothyroidism, severe dilatation of the heart cavities, pulmonary heart, myocarditis, with alkalosis, in elderly patients. With the simultaneous use of digoxin and diuretics, glucocorticoids, insulin, calcium preparations, the risk of glycoside intoxication is also increased. Reduce the absorption of digoxin antacids containing aluminum, cholestyramine, tetracyclines, laxatives. Quinidine, verapamil, spironolactone increase the concentration of digoxin in the blood plasma.

Manufacturer. Digoxin ORION, Finland; Digoxin (Digoxin) WEIMER PHARMA, Germany; Dilanacin AWD, Germany; Lanicor PLIVA, Croatia; Lanoxin WELLCOME, UK.

The use of the drug digoxin is only prescribed by a doctor, the instructions are given for reference!

Digoxin. lanicor. new digital

Digoxin is commonly used to treat heart failure, a condition where the heart is unable to pump enough blood. Symptoms of heart failure include fatigue, shortness of breath, swelling (especially of the legs and knees), and tachycardia. Digoxin is also used to treat some forms of tachycardia and for arrhythmias.

Before prescribing digoxin for the treatment of heart failure, your doctor should first try a drug from the thiazide diuretic group. Digoxin should only be switched to if diuretics fail to maintain blood pressure at the desired level. In general, if you are over 60, you should take a smaller dose than the usual 0.25 milligrams per day, especially if you have reduced kidney function.

When taking digoxin, there is a risk of overdose. While you are taking digoxin, your doctor must regularly check the level of the drug in your blood. You and your healthcare provider should also watch for the first symptoms of an overdose: fatigue, loss of appetite, nausea and vomiting, visual disturbances, restless dreams, nervousness, lethargy, and hallucinations. Other signs of poisoning are heart rhythm disturbances, bradycardia and lethargy. Since the therapeutic range (the range between the minimum effective and toxic dose) is very small, you must take the drug in strict accordance with the doctor's prescriptions. If the concentration of digoxin in the body is too high, this can lead to the appearance of the above symptoms; if the concentration is too low, symptoms of heart failure or tachycardia may occur.

In one study that looked at outpatients taking digoxin, 40 percent of patients had no benefit from digoxin. Due to the presence of toxic side effects of digoxin, taking it in the absence of direct indications is not only useless, but also dangerous. Every fifth patient taking digoxin has toxic side effects, some of which could have been avoided if this drug had not been prescribed unreasonably. There is strong evidence that, on average, eight out of ten patients taking digoxin for a long time could, under the supervision of a physician, stop taking this drug without any negative health consequences. This is primarily due to the fact that digoxin is often prescribed erroneously.

If you are taking digoxin for a long time, talk to your doctor about stopping it. You will most likely be able to stop taking digoxin if the following conditions are met:

1. You have been taking digoxin for a long time, and during this time there were no relapses of heart failure.

2. You have a normal heart rate.

3. You are not using digoxin to treat cardiac arrhythmias.

It is not possible to accurately predict whether a particular patient will be able to stop taking digoxin. People taking digoxin for the treatment of cardiac arrhythmia should not stop taking it, but all other patients should probably try to do so under close supervision by their physician.

You should not take this drug if you have or have experienced: toxic effects from digitalis drugs, ventricular fibrillation.

Inform your doctor if you have or have experienced: drug allergy, high blood calcium levels, lack of thyroid hormones, rheumatic fever, heart block, cartoid sinus hypersensitivity, high or low blood potassium levels, supply disorders oxygen to the heart, arrhythmia or tachycardia, liver or kidney disease, low magnesium levels in the blood, heart attack, severe lung disease, idiopathic hypertrophic subaortic stenosis (heart disease in which the overgrowth of the heart muscle reduces the heart's ability to pump blood.

Tell your healthcare provider what medications you are taking, including aspirin, herbs, vitamins, and other medications.

Learn to measure your pulse, and call emergency medical help immediately if your pulse drops to 50 beats per minute or less, even if you feel great. Patients have been reported to develop bradycardia and heart failure due to digoxin use.

Do not suddenly stop taking this drug. Your doctor should create a schedule for you to gradually decrease your dose of the drug to reduce the risk of serious changes in heart function.

Wear a medical identification bracelet or card showing that you are taking digoxin.

Eat a diet that is high in potassium-rich foods, adequate magnesium, and low in salt and fiber.

Do not take any other medicines without first talking to your doctor - especially over-the-counter appetite control, asthma, colds, coughs, hay fever, sinusitis.

If you are having surgery, including dental work, tell your doctor that you are taking this drug.

Crush the tablets and mix them with water, or swallow them whole with water. Take at least one hour before or two hours after your last meal.

Liquid dosage forms should be measured only with a special pipette.

If you miss a dose of the drug, you should take it as soon as possible, but if the next dose is less than 4 hours away. skip the appointment. Do not take double doses. If you miss two or more appointments in a row, call your healthcare provider.

Aluminum hydroxide, amiodarone, calcium chloride (intravenous), captopril, cholestyramine, cyclophosphamide, cyclosporine, diazepam, erythromycin, furosemide, hydroxychloroquine, ibuprofen, kaolin and pectin, magnesium hydroxide, metoclopramide, neomycin, penicillamine, phenotine, prazosin, prednisone, procarbazine, propafenone has caused "clinically significant" or "clinically significant" interactions when used with this drug. Some other drugs, especially those in the same groups as those listed below, may cause serious side effects when interacting with this drug. As the number of new drugs recommended for sale increases, so does the risk of adverse drug interactions that are often identified with older drugs. Be carefull. Be sure to tell your doctor about all the medicines you are taking, and get your doctor's special attention if you are taking any of the medicines that interact with the drug in question.

Call your doctor right away if you experience signs of an overdose: loss of appetite, nausea, vomiting, pain in the lower part of the stomach, diarrhea, heart rhythm disturbances, slow pulse, abnormal fatigue or weakness, veil or colored "halos" before the eyes, depression or mental confusion , lethargy, headache, restless dreams, hallucinations, nervousness, rash or urticaria, fainting.

Ask your doctor which of the following tests you should have periodically while taking this drug: blood pressure and pulse checks, heart function tests such as an electrocardiogram (ECG), kidney function tests, liver function tests, liver function tests determining the level of potassium, magnesium and calcium in the blood, tests to determine the level of digoxin in the blood.

During pregnancy, the drug should be used only if absolutely necessary. Before taking this medicine, inform your doctor if you are pregnant or suspect that you are pregnant.

The Encyclopedia of Drug Safety is based on the translation of the book Worst pills Best pills by Sidney M. Wolf, as well as data from other sources.

Drug safety is not a refusal to use drugs, but the competent use of the necessary medicine at the right time.

This information is presented in order to make it easier for the patient, together with the doctor, to cope with the disease without negative consequences.

Everything related to health and medicine can be potentially dangerous, even ordinary food.

Content

To restore the rhythm of the myocardium in heart failure, doctors prescribe the drug Digoxin (Digoxin) in a full course. This medication is a pharmacological group of cardiac glycosides, has a systemic effect in the body. Before starting conservative treatment of heart failure and disturbed rhythm of myocardial contractions in this way, it is required to individually consult with a cardiologist and carefully study the instructions.

Composition and form of release

The drug Digoxin is produced in the form of white flat-cylindrical tablets and a clear solution for intravenous administration. Features of the chemical composition:

Mechanism of action of Digoxin

The drug, being a cardiotonic agent, increases the functional activity of the heart. The active substance is a glycoside of the foxglove plant. Pharmacological properties:

1. inotropic effect. The concentration of calcium ions in cardiomyocytes increases, activating contractions of muscle fibers. Systole (myocardial contraction) becomes more powerful, diastole (relaxation) time is prolonged.
2. vasoconstrictor effect. The drug increases the tone of blood vessels, stimulates blood flow and myocardial contractility.
3. chronotropic effect. The drug, having a direct effect on the structures of the autonomic nervous system and the sinus node, reduces the heart rate.

With progressive hypoxia (lack of oxygen), Digoxin increases lung oxygenation by acting on chemoreceptors. Digitalis woolly reduces the speed of nerve impulses passing through the atrioventricular node. The active substance is adsorbed from the digestive canal, penetrating from the intestine into the bloodstream. Eating slows down the absorption of components, but does not affect the bioavailability. The drug is excreted from the body unchanged in the urine. The half-life lasts up to 50 hours.

Indications for use Digoxin

The drug Digoxin is a cardiac glycoside, which acts as part of complex therapy. The instructions contain medical indications for the use of this medication:

• congestive heart failure;
• supraventricular tachycardia;
• atrial fibrillation;
• tachysystolic arrhythmia (atrial flutter);
• circulatory failure in heart disease.

Method of application and dosage

According to the instructions for use, Digoxin is intended for oral administration in a full course. The doctor determines the course of treatment individually, based on the diagnosis, the form of release of the medication, and the characteristics of the affected organism. With a recent treatment with cardiac glycosides, the cardiologist adjusts the daily dose (first reduces, then gradually increases).

Digoxin in ampoules

Therapeutic solution is intended for intravenous or intramuscular administration by jet or drip. Daily doses depend on the diagnosis and age of the patient, are described in detail in the instructions for use:

• supraventricular arrhythmia of a paroxysmal form: intravenous administration, drip, dosage - 0.25–1 mg per day;
• moderately rapid digitalization: intravenous administration, daily dosage - 0.25 mg three times a day, then maintenance therapy - once a day, 0.125-0.25 mg;
• slow digitalization: intravenous administration, daily dosage - 0.5 mg for 1 - 2 approaches.

This form of release is intended for oral use. Recommended dosages for patients over 10 years of age are described in detail in the instructions:

• moderately fast digitalization: emergency therapy - 0.75–1.25 mg in 2 sets;
• slow digitalization: a weekly course is required to take 0.125-0.5 mg 1 time per day, then switch to maintenance therapy;
• maintenance therapy: 0.125–0.75 mg in a long course as recommended by the attending physician.

special instructions

According to the instructions for use, daily doses of Digoxin are adjusted for certain categories of patients. For example, for patients with chronic heart failure, the recommended dosage should not exceed 0.25 mg, with a weight of more than 85 kg - up to 0.375 mg. The daily dose for elderly patients is 0.0625–0.125 mg. The manual also contains other recommendations:

1. In the course of drug therapy, it is required to regularly conduct an ECG, monitor the concentration of electrolytes in the blood serum.
2. In case of renal failure, in order to avoid acute intoxication of the body, the dosage of the drug is reduced: with creatinine clearance (CC) of 50-80 ml / min - by 50%, CC less than 10 ml / min - by 75%. In addition, it is necessary to control the concentration of Digoxin in the blood serum once every 2 weeks.
3. The risk of intoxication with glycosides increases with hypothyroidism, hypomagnesemia, cor pulmonale, hypokalemia, severe dilatation of the heart cavities, hypercalcemia, hypernatremia, myocarditis.
4. Patients with contact lenses during treatment are required to temporarily abandon their daily wear, switch to glasses.
5. The chemical composition of the drug contains potato starch, sucrose, lactose, glucose, which is important to remember when prescribing a drug for patients with diabetes mellitus.
6. The use of Digoxin in idiopathic subaortic stenosis provokes an increase in symptoms of obstruction.
7. The dosage of the drug recommended in the instructions is reduced in case of chronic cor pulmonale, impaired water and electrolyte balance, coronary insufficiency, renal or hepatic insufficiency.
8. Taking the medication disrupts psychomotor functions, depresses the functioning of the nervous system, therefore, when treating with Digoxin, it is required to refuse to drive a vehicle, not to engage in work that requires a high concentration of attention.

During pregnancy

Detailed instructions for the use of Digoxin informs that this medication is not recommended for use during gestation and during breastfeeding. The active substance crosses the placental barrier and is excreted in high concentrations in breast milk. If treatment is necessary, lactation must be temporarily stopped and the baby should be transferred to adapted mixtures. Pregnant women are prescribed another medication with a more gentle effect on the fetus.

drug interaction

Since cardiac glycosides are becoming part of complex therapy, it is important to study information about drug interactions. Such information is provided in the instructions for use of Digoxin:

1. It is forbidden to combine the indicated medication with tannins, acids, alkalis, salts of heavy metals.
2. Symptoms of glycoside intoxication increase with simultaneous use with calcium salts, insulin, diuretics, sympathomimetics, glucocorticosteroids.
3. The concentration of Digoxin in the blood increases in combination with Quinidine, Verapamil, Amiodarone and Erythromycin.
4. Simultaneous use of cardiac glycoside with Propranolol, Reserpine, Phenytoin increases the risk of ventricular arrhythmias.
5. The combination with Amphotericin B, sodium phosphate increases the likelihood of glycoside intoxication against the background of hypokalemia.
6. Phenylbutazone, barbiturates, potassium preparations reduce the therapeutic effect of the drug, and in combination with the antibiotics Erythromycin and Gentamicin, the concentration of glycoside in the blood plasma increases.
7. Simultaneous use of the drug with Cholestyramine, magnesium laxatives, Cholestipol impairs the absorption of Digoxin in the intestine.
8. The metabolism of cardiac glycosides is accelerated by drugs such as Rifampicin, Sulfosalazine.
9. Thyroid hormones enhance cellular metabolism, in combination with Heparin, the anticoagulant effect of the latter weakens.
10. To reduce the toxic effects of glycosides, a solution of magnesium sulfate is prescribed.

Side effects of Digoxin

When used correctly, this medication is well tolerated by the body. Doctors do not exclude the occurrence of side effects at the beginning of the course:

• digestive tract: anorexia, nausea, vomiting, diarrhea, gastralgia, signs of dyspepsia, necrosis of part of the intestine;
• cardiovascular system: sinus bradycardia, paroxysmal ventricular tachycardia, ventricular extrasystole, nodal tachycardia, atrial fibrillation or flutter;
• sensory organs: flies before the eyes, seeing objects in yellow-green hues (xanthopsia), decreased visual acuity;
• nervous system: neuritis, dizziness, paresthesia, sciatica, confusion, fainting, visual hallucinations, a state of euphoria;
• hematopoietic organs: petechiae, nosebleeds, thrombocytopenia;
• allergic reactions: skin itching and rash, urticaria, swelling, hyperemia of the epidermis, erythema of the skin;
• others: hypokalemia, gynecomastia.

Overdose

With a systematic excess of the recommended doses of glycoside in the body, side effects increase.. The patient complains of pronounced signs of dyspepsia, atrioventricular blockade, peripheral paresthesia, delirious psychosis, drowsiness, signs of depression. In such a clinical case, it is necessary to use a specific antidote: sodium or calcium edetate (EDTA), sodium dimercaptopropanesulfonate, antibodies to digoxin. Next, intestinal sorbents are prescribed, for example, activated charcoal. Treatment is symptomatic.

Contraindications

Digoxin in the form of tablets or solution is not allowed to be used by all patients. The instructions for use contain a capacious list of medical contraindications:

• Adams-Stokes-Morgagni syndrome;
• isolated mitral valve stenosis;
• ventricular tachycardia;
• Wolff-Parkinson-White syndrome;
• bradycardia;
• glycoside intoxication;
• constrictive pericarditis;
• hypertrophy of the interventricular septum;
• cardiomyopathy;
• atrioventricular block;
• hypercalcemia, hyperkalemia;
• aneurysm of the thoracic aorta;
• acute myocardial infarction;
• amyloidosis of the heart;
• hypertrophic obstructive cardiomyopathy;
• unstable angina;
• tamponade of the heart muscle;
• hypertrophic subaortic stenosis;
• ventricular fibrillation;
• recurrent diseases of the liver, kidneys;
• age up to 3 years;
• hypersensitivity to the active substances of the glycoside.

Terms of sale and storage

Digoxin in solution and tablet form is a prescription drug. According to the instructions, it is required to store the medicine in a cool, dry place, away from small children. The shelf life of the tablets is 3 years, the solution is 5 years.

Analogues

If the drug is not suitable or worsens the patient's well-being, the doctor introduces a replacement. Reliable analogues of Digoxin:

1. Novodigal. The drug is characterized by the rapid accumulation of components in the tissues, is available in the form of a solution. According to the instructions, the therapeutic effect occurs 1-2 hours after the application of a single dose.
2. Celanide. A reliable substitute for Digoxin in the form of tablets, recommended for tachycardia, heart failure of 2 and 3 degrees. Before the onset of the cumulative effect, 4-6 hours pass.

Digoxin price

The average cost of a drug is up to 100 rubles. The price depends on the form of release, configuration, manufacturer and place of purchase.

Digoxin is a medium-acting, highly lipophilic cardiac glycoside derived from the leaves of woolly foxglove.

Pharmacologically characterized by vasodilating, moderate diuretic and inotropic (changes the force of contraction of the heart) effects.

The use of Digoxin contributes to:

• Increasing the refractory period.
• Increase in systolic and stroke volume of the heart.
• Decreased atrioventricular conduction and heart rate.

In the case of cardiovascular insufficiency, this agent has a pronounced vasodilating effect. Its use reduces the severity of edema and shortness of breath, and also has a mild diuretic effect.

It has a vasodilating and moderately diuretic properties, and also has a positive inotropic effect based on direct inhibition of the Na+-K+-ATPase membrane of cardiomyocytes.

Digoxin promotes an increase in the intracellular concentration of sodium and a decrease in potassium, and as a result, an increase in the exchange of sodium and calcium, leading to an increase in the content of the latter. Thus, it affects the contractility of cardiomyocytes, which increase the strength of myocardial contractions.

With the improvement of the work of the heart muscle, the size of the myocardium and the need for oxygen decrease, with congestion of cardiovascular insufficiency, the drug exhibits vasodilating properties, also having a mild diuretic effect, leads to a decrease in edema.

Bioavailability in the form of tablets is 60-80%, the solution for injection is 100%. The concentration in the myocardium is much higher than the concentration in the blood plasma. Digoxin also has pronounced cumulative properties, it is excreted mainly by the kidneys.

Indications for use

What is Digoxin for? According to the instructions, the drug is prescribed in the following cases:

• Chronic heart failure II (with clinical manifestations) and III-IV functional class according to the NYHA classification - as part of complex therapy;
• Atrial fibrillation and flutter of a chronic and paroxysmal course in a tachysystolic form, especially with concomitant chronic heart failure.

Solution for intravenous administration:

• Chronic heart failure with atherosclerotic cardiosclerosis, decompensated valvular heart disease, myocardial overload in arterial hypertension, especially with a constant form of atrial flutter or tachysystolic atrial fibrillation;
• Paroxysmal supraventricular arrhythmias (atrial flutter, atrial fibrillation, supraventricular tachycardia).

Instructions for use Digoxin, dosage

The doctor sets the dose individually. For patients who took cardiac glycosides, the dose should be reduced.

Standard doses of Digoxin according to the instructions for use:

• Adults for rapid digitalization inside are prescribed 0.5–1 mg, and then every 6 hours, 0.25–0.75 mg for 2–3 days. After the patient's condition improves, they are transferred to a maintenance dose (0.125-0.5 mg / day in 1-2 doses).
• With slow digitalization, treatment is immediately started with a maintenance dose (0.125-0.5 mg / day in 1-2 doses). Saturation in this case occurs approximately 1 week after the start of therapy.
• Children under the age of 2 years for rapid digitalization are prescribed at the rate of 0.04-0.08 mg / kg / day, over 2 years old - 0.03-0.06 mg / kg / day.
• For slow saturation, it is prescribed in a dose that is 1/4 of the dose for rapid saturation in children of this age group.

For patients with chronic heart failure, the daily dose should not exceed 0.25 mg, with a body weight of more than 85 kg - no more than 0.375 mg.

Solution for intravenous administration

• Moderately rapid digitalization - intravenously at 0.25 mg 3 times a day (after which the patient is transferred to maintenance therapy - intravenously 0.125-0.25 mg 1 time per day).
• Slow digitalization - up to 0.5 mg per day (in 1-2 doses).
• Paroxysmal supraventricular arrhythmia - daily dose - 0.25-1 mg (in/in drip or jet).
• A saturating dose for children is 0.05-0.08 mg per 1 kg of weight per day, with moderately fast digitalization it is administered for 3-5 days, with slow digitalization - 6-7 days.
• The maintenance dose for children is 0.01-0.025 mg per 1 kg of the child's weight per day.

Digoxin should be used under medical supervision, with regular ECG, determination of the level of electrolytes in the blood serum.

Side effects

The instruction warns of the possibility of developing the following side effects when prescribing Digoxin:

• Gastrointestinal disorders: nausea, vomiting, constipation or diarrhea, lack of appetite.
• Endocrine system disorders: with prolonged use, gynecomastia may develop.
• Disorders of the cardiovascular system: changes in heart rate in case of overdose.
• Violation of the functioning of the central nervous system: flies, psychosis, photophobia, fatigue, depression, apathy, diplopia, headaches.
• Pathologies from the hematopoietic system: petechiae, thrombocytopenia; allergic manifestations: itching, urticaria.

Solution for intravenous administration:

• Cardiovascular system: AV blockade, bradycardia, cardiac arrhythmias; isolated cases - thrombosis of mesenteric vessels;
• Nervous system: fatigue, headache, dizziness; rarely - decreased visual acuity, xanthopsia, flickering of "flies" before the eyes, macro- and micropsia, scotomas; isolated cases - sleep disturbances, depression, syncope, confusion, euphoria, delirious state;
• Digestive system: nausea, vomiting, anorexia, diarrhea;
• Endocrine system: gynecomastia (with prolonged use).

Contraindications

Digoxin is contraindicated in the following cases:

• Intolerance to the components of the drug or hypersensitivity to them.
• Adams-Stokes-Morgagni syndrome is a violation of the conduction of a nerve impulse.
• Glycoside intoxication (poisoning) of the body.
• Atrioventricular blockade (violation of the passage of a nerve impulse through the atrioventricular node) II-III degree, including WPW syndrome.
• Ventricular tachycardia is an increase in the frequency of contractions of the ventricles of the heart, associated with the presence in them of an ectopic (atypical) focus of generation of nerve impulses.
• Violation of mineral metabolism with an increase in the level of calcium ions (hypercalcemia) and a decrease in the level of potassium ions (hypokalemia).
• A pronounced decrease in the frequency of contractions of the heart (bradycardia).
• Aneurysm (formation of a sac-like protrusion of the wall) of the thoracic aorta.
• Acute period after a heart attack (death of a section of the heart muscle) of the myocardium.
• The presence of additional fibers of the conducting system of the heart (atrioventricular pathways).
• Hypertrophic obstructive cardiomyopathy (thickening of the myocardial wall in one of the ventricles with impaired filling of its cavity with blood).
• Isolated stenosis (narrowing) of the mitral valve.
• Unstable angina is a pronounced malnutrition of the heart muscle, which significantly increases the risk of developing myocardial infarction.
• Ventricular fibrillation is the lack of effective contraction due to chaotic and non-simultaneous contraction of muscle fibers.
• Cardiac tamponade - squeezing of its departments with pericardial effusion (accumulation of fluid in the cavity of the heart sac or pericardium), hemorrhages in the pericardial cavity.
• Hypertrophic subaortic stenosis is a narrowing of the exit from the left ventricle into the aorta, preventing the normal ejection of blood during systole.

It is used with caution in atrioventricular blockade of the 1st degree, weakness of the sinus node, severe dilatation (expansion) of the atrial or ventricular cavities.

Before starting the use of Digoxin, an examination is carried out aimed at identifying or eliminating possible contraindications.

Overdose

In case of overdose, symptoms of glycoside intoxication develop, which include nausea, vomiting, diarrhea, abdominal pain, tachycardia (significant increase in heart rate), atrioventricular blockade, delirious psychosis, staining of visible objects in yellow-green color, the appearance of "flies" before the eyes, drowsiness, peripheral paresthesia (impaired skin sensitivity).

Antidotes are administered, which are sodium dimercaptopropanesulfonate, sodium or calcium edetate (EDTA), antibodies to digoxin. Intestinal sorbents (activated charcoal) and symptomatic therapy are also required.

Overdose treatment is carried out only in a hospital under constant monitoring of cardiac activity using electrocardiography.

Digoxin analogues, price in pharmacies

If necessary, you can replace Digoxin with an analogue of the active substance - these are drugs:

1. digitoxin,
2. Novodigal,
3. Korglikon.

ATX code:

• Novodigal.

When choosing analogues, it is important to understand that the instructions for use of Digoxin, the price and reviews of drugs of similar action do not apply. It is important to consult a doctor and not to make an independent replacement of the drug.

Price in Russian pharmacies: Digoxin 0.25 mg 30 tablets. - from 32 to 38 rubles, 50 tablets - from 45 to 55 rubles, a solution of 0.025% 1 ml 10 ampoules - from 47 rubles, according to 729 pharmacies.

Store in a place protected from light at a temperature of 15-25 °C. Keep away from children. The shelf life of the tablets is 2 years, the solution is 5 years. Conditions for dispensing from pharmacies - by prescription.

Interactions

Can not be combined with alkalis, acids, salts of heavy metals and tannins. When used together with diuretics, insulin, calcium salt preparations, sympathomimetics, glucocorticosteroids, the risk of symptoms of glycoside intoxication increases.

In combination with quinidine, amiodarone and erythromycin, an increase in the content of digoxin in the blood is noted. Quinidine inhibits the excretion of the active substance.

The calcium channel blocker Verapamil reduces the rate of elimination of digoxin from the body by the kidneys, which leads to an increase in the concentration of cardiac glycoside. This effect of verapamil is gradually leveled off with long-term co-administration of drugs (more than six weeks).

The combination with amphotericin B increases the likelihood of developing an overdose of glycosides due to hypokalemia, which provokes amphotericin B.

Hypercalcemia increases the susceptibility of cardiomyocytes to cardiac glycosides, and therefore, intravenous calcium preparations should not be resorted to in patients who take cardiac glycosides.

Simultaneous administration of Digoxin in combination with reserpine, propranolol, phenytoin increases the likelihood of developing ventricular arrhythmias.

Reduce the concentration and effectiveness of Digoxin phenylbutazone and drugs of the barbiturate group. Also reduce the therapeutic effect of potassium preparations, drugs that lower the acidity of gastric juice, metoclopramide.

When combined with antibiotics erythromycin and gentamicin, the glycoside content in the patient's plasma increases. Simultaneous administration of the drug with cholestipol, cholestyramine and magnesium laxatives leads to a deterioration in the absorption of the drug in the intestine, as a result of which there is a decrease in the amount of digoxin in the body.

Metabolism of glycosides is accelerated when combined with rifampicin and sulfosalazine.