PEBC: What You Need to Know: Digoxin

Indications:

Heart Failure and Atrial Fibrillation (Rate Control)

Dosing:

0.625 mg to 0.25 mg once daily

(most patients these days require 0.125 mg/day)

-reserve use in sedentary individuals because it is not effective at high heart rates

-reserve as last line in heart failure and atrial fibrillation

-adjust dose in renal failure

Measuring Digoxin Levels:

-target level in heart failure is lower end of range (0.5 to 0.9 ng/mL)

-wait at least 6 to 8 hours because of long distribution phase

Adverse Effects:

-visual field change (yellow-green vision)

-nausea, vomiting, anorexia, diarrhea

-confusion

-dizziness

-in overdose and electrolyte abnormalities: arrhythmias (monitor ECG) and use digibind as a reversal agent

Drug Interactions:

-pgp inhibitors: digoxin is a pg-p substrate, so caution with inhibitors such as clarithromycin, erythormycin, amiodarone and quinidine

-calcium channel blockers and beta blockers: caution due to bradycardia