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- What is digoxin, and how does it work (mechanism of action)?
- What brand names are available for digoxin?
- Is digoxin available as a generic drug?
- Do I need a prescription for digoxin?
- What are the uses for digoxin?
- What are the side effects of digoxin?
- What is the dosage for digoxin?
- Which drugs or supplements interact with digoxin?
- Is digoxin safe to take if I'm pregnant or breastfeeding?
- What else should I know about digoxin?
What is digoxin, and how does it work (mechanism of action)?
- 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 are the uses 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.
Quick GuideHeart Disease: Symptoms, Signs, and Causes
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.
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.
REFERENCE: FDA Prescribing Information
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Arrhythmia (Irregular Heartbeat)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 prmature contraction.
Atrial Fibrillation QuizLearn the causes, symptoms, and treatments of the common heart abnormality known as atrial fibrillation (A-fib).
Chest PainChest 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.
Congestive Heart Failure (CHF) OverviewCongestive 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.
Heart AttackHeart attack happens when a blood clot completely obstructs a coronary artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical instability of the heart.
Heart Disease (Coronary Artery Disease)
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:
- High blood pressure
- High cholesterol
- Family history
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.
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,
- 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.
Heart: How the Heart WorksThe 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.
Premature Ventricular ContractionsPremature ventricular contractions (PVCs, 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.
Stress and Heart DiseaseThe 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.
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.