Digoxin

Digoxin

Class: Cardiac glycoside
Indications: prevention and treatment of angina pectoris.

Requires a loading dose.

*derived from foxglove
·         Increases intracellular  ca++, and allows more ca++ to enter cell during depolarization
·         Increased myocardial contraction(inotropic effect)
·         ^ CO & ^ renal perfusion(stops angio-renin)-> ^ Urine output (diuretic) &  v BVol
·         V HR due to slower repolarization( a –ve chronotropic effect)
·         Decreased conduction velocity through AV node
Adverse:
 Headache, weakness, drowsiness, and vision changes
–GI upset and anorexia
–Arrhythmia development

Contraindications:
-          tachycardia or fibrillation, heart block, or sick sinus syndrome
–Idiopathic hypertrophic subaortic stenosis
–Acute MI, renal insufficiency, and electrolyte abnormalities

Caution:

  • -          digitoxin toxicity: symptoms : anorexia, nausea, vomiting, malaise, depression, irregular heart rythms. 
  •        toxicity causes hyperkalaemia
  •     Antidote is DIGOXIN IMMUNE FAB.

–Pregnancy and lactation–Children and older adults

Drug to drug: increased effects with: verapamil, amiodarone, quinidine, quinine, erythromycin, tetracycline or cyclosporine, potassium losing diuretics. Do not take antihistamines .There are further drugs on this list.
Drug herb: St Johns wort and psyllium can decrease effectiveness. Toxicity with ginseng, hawthorn and licorice.

Teaching: cautions of the adverse effects,

  • take apical pulse for 1 full minute before administering to assess. If less than 60 wait 1 hour and retake pulse, if still less than 60, do not give drug. 
  • In older adults check hydration(loose skin , mucous membranes dry), if body mass is low, or renal dysfunction monitor closely. 
  • Weigh daily to monitor fluid retention. 
  • Drug is excreted through kidneys, and toxicity could develop if kidneys are dysfunctional and do not excrete drug.



Children: narrow margin for the therapeutic dose.

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