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What is digoxin, and how does it work?
- Digoxin increases the strength and efficiency of heart contractions, and is useful in the treatment of heart failure and control the rate and rhythm of the heart. It is extracted from the leaves of a plant called digitalis lanata. Digoxin increases the force of contraction of the muscle of the heart by inhibiting the activity of an enzyme (ATPase) that controls movement of calcium, sodium, and potassium into heart muscle. Calcium controls the force of contraction. Inhibiting ATPase increases calcium in heart muscle and therefore increases the force of heart contractions. Digoxin also slows electrical conduction between the atria and the ventricles of the heart and is useful in treating abnormally rapid atrial rhythms such as atrial fibrillation, atrial flutter, and atrial tachycardia. (Abnormally rapid atrial rhythms can be caused by heart attacks, excessive thyroid hormones, alcoholism, infections, and many other conditions.) During rapid atrial rhythms, electrical signals from the atria cause rapid contractions of the ventricles. Rapid ventricular contractions are inefficient in pumping blood containing oxygen and nutrients to the body, causing symptoms of weakness, shortness of breath, dizziness, and even chest pain. Digoxin alleviates these symptoms by blocking the electrical conduction between the atria and ventricles, thus slowing ventricular contractions.
- The FDA approved digoxin in 1975.
What brand names are available for digoxin?
Lanoxin, Lanoxin Pediatric
Is digoxin available as a generic drug?
GENERIC AVAILABLE: Yes
Do I need a prescription for digoxin?
What are the side effects of digoxin?
Common side effects include
Many digoxin side effects are dose dependent and happen when blood levels are over the narrow therapeutic range. Therefore, digoxin side effects can be avoided by keeping blood levels within the therapeutic level. Serious side effects associated with digoxin include
- heart block,
- rapid heartbeat, and
- slow heart rate.
Digoxin has also been associated with visual disturbance (blurred or yellow vision), abdominal pain, and breast enlargement. Patients with low blood potassium levels can develop digoxin toxicity even when digoxin levels are not considered elevated. Similarly, high calcium and low magnesium blood levels can increase digoxin toxicity and produce serious disturbances in heart rhythm.
What is the dosage for digoxin?
- Digoxin may be taken with or without food.
- Digoxin primarily is eliminated by the kidneys; therefore, the dose of digoxin should be reduced in patients with kidney dysfunction.
- Digoxin blood levels are used for adjusting doses in order to avoid toxicity.
- The usual starting dose is 0.0625-0.25 mg daily depending on age and kidney function.
- The dose may be increased every two weeks to achieve the desired response.
- The usual maintenance dose is 0.125 to 0.5 mg per day.
Which drugs or supplements interact with digoxin?
- Drugs such as gentamicin, tetracycline, ranolazine (Ranexa), verapamil (Calan, Verelan, Verelan PM, Isoptin, Isoptin SR, Covera-HS), quinidine (Quinaglute, Quinide), amiodarone (Cordarone), indomethacin (Indocin, Indocin-SR), alprazolam (Xanax, Xanax XR, Niravam), spironolactone (Aldactone), and itraconazole (Sporanox) can increase digoxin levels and the risk of toxicity. The co-administration of digoxin and beta-blockers (for example propranolol [Inderal, Inderal LA]) or calcium channel blockers or CCBs (for example, verapamil), which also reduce heart rate, can cause serious heart rate slowing.
- Diuretic-induced (for example, by furosemide [Lasix]) reduction in blood potassium or magnesium levels may predispose patients to digoxin-induced abnormal heart rhythms.
- Saquinavir (Invirase) and ritonavir (Norvir) increase the amount of digoxin in the body and may cause digoxin toxicity.
- Mirabegron (Mybetriq) increases digoxin blood levels. The lowest dose of digoxin should be used if by people who are also using mirabegron.
- Omeprazole (Prilosec) and other drugs that reduce stomach acidity may increase blood levels of digoxin.
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Is digoxin safe to take if I'm pregnant or breastfeeding?
- There are no adequate studies in pregnant women.
- Digoxin in secreted in breast milk at concentrations similar to concentrations in the mothers blood. However, the total amount of digoxin that will be absorbed from breast milk by the infant may not be enough to cause effects. Caution should be exercised by nursing mothers who are taking digoxin.
What else should I know about digoxin?
What preparations of digoxin are available?
- Tablets: 0.0625, 0.125, 0.1875, and 0.25 mg; Elixir: 0.05 mg/ml.
- Injectable Solution: 0.1 and 0.25 mg/ml.
How should I keep digoxin stored?
Digoxin should be stored at room temperature, 15 C and 30 C) (59 F and 86 F) and protected from light.
Digoxin (Lanoxin, Lanoxin Pediatric) is used in the treatment of congestive heart failure and abnormally rapid atrial rhythms (atrial fibrillation, atrial flutter, atrial tachycardia). Review side effects, drug interactions, dosage, and pregnancy and breastfeeding information before using this medication.
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Related Disease Conditions
Congestive Heart Failure (CHF)
Congestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual.
Thrombocytopenia (Low Platelet Count)
Thrombocytopenia (low platelet count) refers to a decreased number of platelets in the blood. Symptoms of thrombocytopenia include: Increased bruising Spontaneous bleeding Small, purple spots under the skin called purpura There are many causes of thrombocytopenia such as decreased platelet production (viral infections for example rubella, mumps, chickenpox, hepatitis C, and HIV); increased platelet destruction or consumption (for example sulfonamide antibiotics, heparin, blood transfusions, and lupus); or increased splenic sequestration (enlarged spleen due to conditions, for example, liver disease, blood cancers, and more). Treatment of thrombocytopenia depends on the cause.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
How the Heart Works
The heart is a very important organ in the body. It is responsible for continuously pumping oxygen and nutrient-rich blood throughout your body to sustain life. It is a fist-sized muscle that beats (expands and contracts) 100,000 times per day, pumping a total of five or six quarts of blood each minute, or about 2,000 gallons per day.
Heart Attack (Myocardial Infarction)
A heart attack occurs when a blood clot completely obstructs a coronary artery supplying blood to the heart muscle. Learn about warning signs, causes, complications, risk factors, and treatment.
Heart disease (coronary artery disease) occurs when plaque builds up in the coronary arteries, the vessels that supply blood to the heart. Heart disease can lead to heart attack. Risk factors for heart disease include: Smoking High blood pressure High cholesterol Diabetes Family history Obesity Angina, shortness of breath, and sweating are just a few symptoms that may indicate a heart attack. Treatment of heart disease involves control of heart disease risk factors through lifestyle changes, medications, and/or stenting or bypass surgery. Heart disease can be prevented by controlling heart disease risk factors.
Arrhythmias (Heart Rhythm Disorders)
Heart rhythm disorders vary from minor palpitations, premature atrial contractions (PACs), premature ventricular contractions (PVCs), sinus tachycardia, and sinus bradycardia, to abnormal heart rhythms such as tachycardia, ventricular fibrillation, ventricular flutter, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia (PSVT), Wolf-Parkinson-White syndrome, brachycardia, or heart blocks. Treatment is dependent upon the type of heart rhythm disorder.
Premature Ventricular Contractions (PVCs)
Premature ventricular contractions (PVC) are premature heartbeats originating from the ventricles of the heart. PVCs are premature because they occur before the regular heartbeat. There are many causes of premature ventricular contractions to include: heart attack, high blood pressure, congestive heart failure, mitral valve prolapse, hypokalemia, hypoxia, medications, excess caffeine, drug abuse, and myocarditis.
Heart failure (congestive) is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include congested lungs, fluid and water retention, dizziness, fatigue and weakness, and rapid or irregular heartbeats. There are two types of congestive heart failure, systolic or left-sided heart failure; and diastolic or right-sided heart failure. Treatment, prognosis, and life-expectancy for a person with congestive heart failure depends upon the stage of the disease.
Atrial Fibrillation (AFib)
Atrial fibrillation (AF or AFib) is an abnormality in the heart rhythm, which involves irregular and often rapid beating of the heart. Symptoms may include heart palpitations, dizziness, fainting, fatigue, shortness of breath, and chest pain. Atrial fibrillation treatment may include medication or procedures like cardioversion or ablation to normalize the heart rate.
Atrial Flutter: ECG, Symptoms, and Treatments
Atrial flutter is a problem with the atria of the heart. In atrial flutter the atria of the heart rapidly and repeatedly beat due to an anomaly in the electrical system of the heart. It is a type of arrhythmia and can be dangerous because complications can develop easily. Signs and symptoms of atrial flutter include near fainting, palpitations, mild shortness of breath, and fatigue. While the exact cause of atrial flutter is not clearly understood, it's most likely related to your health, what medical conditions you certainly have, poor diet, lack of exercise, and drinking too much alcohol. Atrial flutter is diagnosed by physical examination, medical history, and a sawtooth ECG wave pattern.
Palpitations are uncomfortable sensations of the heart beating hard, rapidly, or irregularly. Some types of palpitations are benign, while others are more serious. Palpitations are diagnosed by taking the patient history and by performing an EKG or heart monitoring along with blood tests. An electrophysiology study may also be performed. Treatment of palpitations may include lifestyle changes, medication, ablation, or implantation of a pacemaker. The prognosis if palpitations depends on the underlying cause.
An arrhythmia is an abnormal heart rhythm. With an arrhythmia, the heartbeats may be irregular or too slow (bradycardia), to rapid (tachycardia), or too early. When a single heartbeat occurs earlier than normal, it is called a premature contraction.
Paroxysmal Supraventricular Tachycardia (PSVT)
Paroxysmal supraventricular tachycardia (PSVT) is an abnormal conduction of electricity in particular areas of the heart. PSVT was referred to at one time as paroxysmal atrial tachycardia or PAT, however, the term PAT is reserved for as specific heart condition. Symptoms of PSVT include weakness, shortness of breath, chest pressure, lightheadedness, and palpitations. PSVT is treated with medications or procedures that return the heart to its normal electrical pattern.
Heart Attack Treatment
A heart attack involves damage or death of part of the heart muscle due to a blood clot. The aim of heart attack treatment is to prevent or stop this damage to the heart muscle. Heart attack treatments included medications, procedures, and surgeries to protect the heart muscle against injury.
Heart Attacks in Women
Heart disease, particularly coronary artery disease is the leading cause of heart attacks. Women are more likely to die from a heart attack than men. High cholesterol, high blood pressure, obesity, and high triglycerides are contributors to heart disease. Some of the common symptoms of a heart attack in women include chest pain, shortness of breath, nausea, feeling faint or woozy, and more. Heart disease can be prevented by lifestyle changes and controlling high blood pressure, cholesterol, weight, and diseases such as diabetes.
Fitness: Exercises for a Healthy Heart
Regular exercise can help reduce the risk of heart disease. To achieve maximum benefits, do a mix of stretching exercises, aerobic activity, and strengthening exercise. Aim to get 20 to 30 minutes of aerobic exercise at least three to four times a week. Consult a doctor before exercising for the first time, especially if you have health problems.
Heart Disease in Women
Heart disease in women has somewhat different symptoms, risk factors, and treatment compared to heart disease in men. Many women and health professionals are not aware of the risk factors for heart disease in women and may delay diagnosis and treatment. Lifestyle factors such as diet, exercise, tobacco use, overweight/obesity, stress, alcohol consumption, and depression influence heart disease risk in women. High blood pressure, high cholesterol, and diabetes also increase women's risk of heart disease. Electrocardiogram (EKG or ECG), stress-ECG, endothelial testing, ankle-brachial index (ABI), echocardiogram, nuclear imaging, electron beam CT, and lab tests to assess blood lipids and biomarkers of inflammation are used to diagnose heart disease. Early diagnosis and treatment of heart disease in women saves lives. Heart disease can be prevented and reversed with lifestyle changes.
Stress and Heart Disease
The connection between stress and heart disease is not clear. Stress itself may be a risk factor, or high levels of stress may make risk factors for heart disease worse. The warning signs of stress can be physical, mental, emotional, or behavioral. Reducing stressors in an individuals life not only can lead to a more productive life, but may also decrease the risk for heart disease and causes of heart disease.
Smoking and Heart Disease
Smoking increases the risk of heart disease in women and men. Nicotine in cigarettes decrease oxygen to the heart, increases blood pressure, blood clots, and damages coronary arteries. Learn how to quit smoking today, to prolong your life.
Restrictive cardiomyopathy, the rarest form of cardiomyopathy, is a condition in which the walls of the lower chambers of the heart (the ventricles) are abnormally rigid and lack the flexibility to expand as the ventricles fill with blood. The pumping or systolic function of the ventricle may be normal but the diastolic function (the ability of the heart to fill with blood) is abnormal. Therefore, it is harder for the ventricles to fill with blood, and with time, the heart loses the ability to pump blood properly, leading to heart failure.
Heart Disease Treatment in Women
Heart disease treatment in women should take into account female-specific guidelines that were developed by the American Heart Association. Risk factors and symptoms of heart disease in women differ from those in men. Treatment may include lifestyle modification (diet, exercise, weight management, smoking cessation, stress reduction), medications, percutaneous intervention procedure (PCI), and coronary artery bypass grafting (CABG). Heart disease is reversible with treatment.
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