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Updated 11 February 2013

Digoxin

Digoxin is a cardiac glycoside obtained from the digitalis plant species. It is prescribed to treat congestive heart failure.

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Digoxin is the active ingredient of Lanoxin and Purgoxin.

General Information

Digoxin is a cardiac glycoside obtained from the digitalis plant species. It is prescribed to treat congestive heart failure, a condition where the heart battles to cope with its workload, as well as certain types of irregular heart rhythms.

Digoxin has a narrow therapeutic window, meaning that there is a narrow margin between effective and therapeutic doses. Your doctor needs to monitor your treatment carefully, and you should never take more than the prescribed dose of this drug.

You should report any side effects such as heart palpitations, nausea, visual disturbance or confusion to your doctor.

How does digoxin work?

Digoxin has a direct effect on the muscle of the heart. It slows the rate at which the heart beats, while increasing the force thereof.

Fast facts

Drug schedule: Schedule 3

Available as: Digoxin is available as tablets, elixir and injection.

What does it do? Digoxin normalises irregular heart rhythm and reduces the workload of the heart.

Overdose risk: High

Dependence risk: Low

Is digoxin available as a generic? Yes

Is digoxin available on prescription only? Yes

User information

Onset of effect: Within 60 minutes

Duration of action: Up to 3 days

Dietary advice: Food may affect the absorption of digoxin. It should therefore be taken on an empty stomach. Be sure to take plenty of foods rich in potassium (bananas, tomatoes) as low levels of potassium in the body may add to the toxicity of digoxin.

Stopping this medicine: Do not discontinue this drug unless instructed to do so by your doctor. Premature stoppage may have serious consequences.

Prolonged use: No problems expected. Your blood levels of digoxin need to be monitored periodically.

Special precautions

Consult your doctor before using this drug if:

  • You have poor thyroid function
  • You have lung disease
  • You have liver disease
  • You are taking other medication.

Pregnancy: Avoid. Potential risk to the foetus has been reported. Consult your doctor before use, or if you are planning to fall pregnant.

Breastfeeding: Avoid. This medication is passed through breast milk and may affect your baby adversely. Consult your doctor before use.

Porphyria: This medication is safe to use.

Infants and children: Dosage should be determined by your paediatrician.

Elderly: Caution is advised in the elderly as side effects are likely. Dosage may need to be adjusted.

Driving and hazardous work: Caution is advised as use of this medication may lead to dizziness, light-headedness and/or sedation. Avoid such activities until you know how this medication affects you.

Alcohol: No special precautions need to be taken.

Possible side effects

Side effect

Frequency

Consult your doctor

Common

Rare

Only if severe

In all cases

Tiredness

x

x

Loss of appetite

x

x

Nausea/vomiting

x

x

Drowsiness

x

x

Mental confusion

x

x

Visual disturbance

x

x

Erectile dysfunction

x

x

Male breast enlargement

x

x

Palpitations

x

x

Shortness of breath

x

x

Interactions:

Drug interactions:

Amiodarone

Risk of digoxin toxicity

Amphoterecin B

Risk of digoxin toxicity

Benzodiazepines

Risk of digoxin toxicity

Beta blocking drugs

Extreme slow heartbeat may result

IV calcium

Risk of digoxin toxicity

Chloroquine, quinidine, quinine

Risk of digoxin toxicity

Ciclosporin

Risk of digoxin toxicity

Corticosteroids

Risk of digoxin toxicity

Diuretics

Risk of digoxin toxicity

Erythromycin

Risk of digoxin toxicity

Metoclopramide

Lower digoxin levels in body

Non-steroidal anti-inflammatory drugs

Risk of digoxin toxicity

Phenobarbitone/ Phenytoin

Lower digoxin levels in body

Propafenone

Risk of digoxin toxicity

Reserpine

Slow heartbeat & low blood pressure

Rifampicin

Lower digoxin levels in body

Disease interactions

Consult your doctor before using this drug if you have poor thyroid function, lung disease or liver disease.

Overdose action

An overdose of this medication can be fatal. Seek immediate emergency medical attention. Symptoms may include palpitations, chest pain and loss of consciousness.

Recommended dosage

Adults: 0.0625-0.5 mg once a day

Children: 0.01 mg/kg/day in 2 divided doses

Interesting fact

Charles Cullen, a professional nurse, killed as many as 40 hospital patients in the USA over a period of 16 years with 'heart medication'. It is suspected that he used digoxin in most cases.

 
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