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Digoxin: Brands, Price & Uses in Bangladesh
Digoxin is a cardiac glycoside indicated for the following conditions: Heart failure (established/FDA-approved use): Used to improve symptoms and reduce the need for hospitalization in adults with…
About Digoxin
Indications of Digoxin
Digoxin is a cardiac glycoside indicated for the following conditions:
- Heart failure (established/FDA-approved use): Used to improve symptoms and reduce the need for hospitalization in adults with heart failure with reduced ejection fraction (HFrEF), typically as an add-on to standard guideline-directed therapy (ACE inhibitors/ARBs/ARNI, beta-blockers, diuretics, mineralocorticoid receptor antagonists) rather than as first-line treatment.
- Control of ventricular rate in chronic atrial fibrillation (established/FDA-approved use): Used to slow the ventricular response rate in chronic atrial fibrillation, particularly in sedentary patients or those with coexisting heart failure; beta-blockers or non-dihydropyridine calcium channel blockers are generally preferred first-line agents, with Digoxin used as an adjunct or alternative when those are inadequate or contraindicated.
- Certain supraventricular arrhythmias (guideline-supported adjunct use): Occasionally used as adjunct therapy in select supraventricular arrhythmias under specialist cardiology supervision.
Digoxin is not indicated for ventricular arrhythmias and is not a first-line agent for acute heart failure or for rhythm control (conversion to normal sinus rhythm) of atrial fibrillation.
Dosage & Administration of Digoxin
Adult Dose
| Indication | Typical Dosing |
|---|---|
| Heart failure (maintenance) | 0.125 mg to 0.25 mg orally once daily; lower doses (0.0625 mg to 0.125 mg daily) are often used in elderly patients or those with renal impairment. |
| Atrial fibrillation (rate control) | Loading ("digitalization") is rarely used today; when needed, it is given under close monitoring, followed by a maintenance dose similar to that used in heart failure, individualized using serum Digoxin concentration and clinical response. |
Pediatric Dose
Pediatric dosing of Digoxin is weight- and age-based and must be individualized by a pediatric cardiologist or specialist; per-kilogram doses are generally higher in neonates and infants than in older children and adults, reflecting differences in drug distribution. Safety and efficacy have been established for use in pediatric heart failure and certain supraventricular arrhythmias under specialist supervision; Digoxin should not be dosed in children without specialist guidance.
Renal Impairment
Digoxin is cleared predominantly by the kidneys, so patients with renal impairment require lower doses and closer monitoring of serum Digoxin concentration, renal function, and electrolytes to avoid accumulation and toxicity.
Hepatic Impairment
No specific dose adjustment is generally required for hepatic impairment, since Digoxin undergoes minimal hepatic metabolism; however, clinical monitoring is still advised.
Side Effects of Digoxin
Side effects of Digoxin are often dose-related and closely tied to serum drug concentration:
- Common: Nausea, vomiting, loss of appetite, diarrhea, dizziness, and headache.
- Signs of toxicity (can occur even in susceptible patients at doses that appear therapeutic): Visual disturbances (blurred vision, halos, or a yellow-green tinge to vision), confusion or drowsiness (especially in the elderly), and cardiac arrhythmias (including a slow heart rate, heart block, or dangerous fast rhythms).
- Uncommon (with long-term use): Gynecomastia (breast enlargement in men).
Patients should seek prompt medical attention if they notice visual changes, irregular heartbeat, severe nausea/vomiting, or confusion while taking Digoxin.
Contraindications of Digoxin
Digoxin is contraindicated in:
- Known hypersensitivity to Digoxin or other digitalis glycosides.
- Ventricular fibrillation.
Additional situations that amount to a near-contraindication and generally warrant avoiding Digoxin unless directed by a cardiac specialist include Wolff-Parkinson-White syndrome with atrial fibrillation (risk of accelerated conduction through an accessory pathway) and certain high-grade atrioventricular blocks in the absence of a pacemaker; see Precautions and Warnings for details.
Frequently Asked Questions about Digoxin
What is Digoxin used for?
Digoxin is used to help the heart pump more effectively in certain patients with heart failure and to slow a fast heart rate in chronic atrial fibrillation.
How should I take Digoxin?
Take Digoxin exactly as prescribed by your physician, at the same time each day, with or without food. Do not change your dose or stop taking Digoxin without consulting your doctor, since both too little and too much Digoxin can be harmful.
What are the warning signs of Digoxin toxicity?
Seek medical attention promptly if you experience nausea, vomiting, loss of appetite, visual changes (such as blurred vision or a yellow-green tinge to your vision), confusion, or an irregular or very slow heartbeat while taking Digoxin, as these can be signs of toxicity, especially given its narrow therapeutic index.
Can Digoxin be taken during pregnancy or breastfeeding?
Digoxin should be used during pregnancy only if clearly needed, since it crosses the placenta, and only under a physician's guidance; it passes into breast milk in small amounts, so breastfeeding mothers should also consult their physician before using Digoxin.
Does Digoxin interact with other medicines?
Yes. Medicines such as amiodarone, verapamil, and quinidine can raise Digoxin levels and increase toxicity risk, while diuretics can cause electrolyte changes that increase the risk of Digoxin-related arrhythmias. Always tell your doctor about all medicines and supplements you take alongside Digoxin.
What should I do if I miss a dose or take too much Digoxin?
If you miss a dose of Digoxin, take it as soon as you remember unless it is almost time for the next dose — do not double up. If you suspect you have taken too much Digoxin, seek immediate emergency medical attention or contact a poison control center, as overdose can cause dangerous heart rhythm problems.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.