Digoxin

Digoxin is a drug from the group of cardiac glycosides.

Improves the heart, helps reduce the load on it, increases cardiac output. It has anti-arrhythmogenic effect, normalizes heart rate and their rhythm. Used to treat chronic heart failure, in the treatment of rhythm disorders (in particular, with tachysystole).

On this page you will find all information about Digoxin: the full instruction on the application for this medicine, average prices in pharmacies, complete and incomplete analogs of the drug, as well as reviews of people who have already used Digoxin. Want to leave your opinion? Please write in the comments.

Clinical and pharmacological group

Cardiac glycoside.

Conditions of leave from pharmacies

It is released on prescription.

Price list

How much is Digoxin? The average price in pharmacies is at the level of50 rubles.

Form of issue and composition

The drug is available in the form of tablets and a solution for intravenous administration with the main active ingredient - digoxin. Its content is in:

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1 tablet - 0.1 mg and 0.25 mg;
1 ml of solution - 0.25 mg.

As auxiliary substances in the composition of tablets include lactose, potato starch, sucrose, calcium stearate, dextrose, talc.

In the pharmacy chain, Digoxin drugs come:

Tablets - in cell contour packs of 10 pieces;
The solution - in ampoules of 1 ml, in packs of cardboard for 5, 10 pieces.

Pharmacological effect

Digoxin is characterized by vasodilating, moderate diuretic and inotropic (changes the force of contraction of the heart) effects.

Using Digoxin contributes:

Increased systolic and stroke volume of the heart.
An increase in the refractory period.
Decreased atrioventricular conduction and heart rate.

In the case of cardiovascular failure, this drug has a pronounced vasodilator effect. Its use reduces the severity of edema and dyspnea, and also has a mild diuretic effect.

Indications for use

Indications for the appointment of Digoxin are such diseases:

Atrial fibrillation and atrial fibrillation.
Paroxysmal supraventricular tachycardia.
Chronic (congestive) cardiovascular failure.

Contraindications

Direct contraindications for the prescription of the drug are signs of glycoside intoxication, hypersensitivity to digoxin, Wolff-Parkinson-White syndrome, atrioventricular blockade of the second degree and complete atrioventricular block, bradycardia.

Contraindicated drug with isolated mitral stenosis. You can not prescribe medication for such manifestations of coronary heart disease as unstable angina and acute period of myocardial infarction.

The pronounced dilatation of the heart, obesity, kidney and liver parenchyma deficiency, myocardial inflammation, hypertrophy of the interventricular septa, subaortal stenosis, ventricular tachyarrhythmias - under these conditions, the use of the drug is unacceptable.

Heart failure of the diastolic type (with cardiac tamponade, with constrictive pericarditis, with amyloidosis of the heart, with cardiomyopathy) is also a contraindication to the appointment of Digoxin.

Application in pregnancy and lactation

This drug is able to penetrate the hematoplacental barrier, in plasma of the fetus is determined in the same concentrations as in the pregnant woman. Excreted in breast milk slightly. However, with lactation against the background of taking digoxin, monitoring of heart rate in a child is necessary. Teratogenic potential in clinical studies has not been identified, however, digoxin for pregnant women should be prescribed only if the benefit is greater than the probable risks to the fetus or the baby.

Instructions for use

In the instructions for use, it is indicated that the tablets of Digoxin are taken orally. The dose is selected individually, taking care. For patients who received cardiac glycosides before the appointment of digoxin, the dose should be reduced.

Recommended dosing for patients older than 10 years:

Slow digitalization: , 25-, mg once a day for 5-7 days, after reaching saturation, they switch to maintenance treatment.
Supportive therapy: the dose is set individually, usually from 0.125 to 0.75 mg; the period of application is appointed by the doctor, as a rule, long-term treatment.
Moderately fast digitalization in emergency therapy: a daily dose of 0.75-1.25 mg with a multiplicity of intake 2 times a day (under the control of electrocardiography (ECG) before each subsequent dose). After reaching saturation (24-36 hours), the patient is transferred to maintenance therapy.

For patients with chronic heart failure, the daily dose should not exceed 0.25 mg, with a body weight of more than 85 kg - not more than 0.375 mg.

For elderly patients, the drug is prescribed in a dose of 0.0625-0. 115 mg.

When treating children 3-10 years, the saturating dose is prescribed, taking into account the weight of the child, 0.05-0.08 mg per kg per day: with a moderately fast digitalization - within 3-5 days, slow digitalization - 6-7 days, maintenance dose - 0.01-0.025 mg per 1 kg per day.

Side effects

When using Digoxin, adverse reactions can develop:

Allergic reactions: rash, hives;
Digestive system: nausea, vomiting, abdominal pain, anorexia, diarrhea, intestinal necrosis;
The system of hematopoiesis and hemostasis: thrombocytopenic purpura, nosebleeds, petechiae;
Body of vision: flashing of "flies" before the eyes, staining of visible objects in a yellowish green color, reduced visual acuity;
Central nervous system: headache, sleep disturbances, neuritis, dizziness, manic-depressive syndrome, paresthesia and syncope, sciatica, disorientation, confusion;
Cardiovascular system: ventricular extrasystole and paroxysmal tachycardia, nodal tachycardia, sinoauric blockade, sinus bradycardia, AV blockade, flutter and atrial fibrillation;

Other: gynecomastia, hypokalemia.

Overdose

If the recommended therapeutic dose is significantly exceeded, the symptoms of glycosidic intoxication develop, which include nausea, vomiting, diarrhea, abdominal pain, tachycardia (a significant increase in the frequency of cardiac contractions), atrioventricular blockade, delirious psychosis, staining of the visible objects in yellow-green color, the appearance of "flies" before the eyes, drowsiness, peripheral paresthesia (a violation of the sensitivity of the skin).

In the case of signs of glycoside intoxication, the tactics depend on the severity of the manifestations: it is enough to reduce the dose of Digoxin with minor overdoses. If there is a progression of side effects, it is worth taking a short break, the duration of which depends on the dynamics of signs of intoxication. Acute poisoning Digoxin requires washing the stomach, taking sorbents in large quantities. The patient is given a laxative.

Ventricular arrhythmias can be eliminated by intravenous administration of potassium chloride with the addition of insulin. Potassium preparations can not be categorically prescribed for slowing the atrioventricular conduction. When the arrhythmia is maintained, intravenously phenytoin is administered. Atropine is used to treat bradycardia. In parallel, they are prescribed oxygen therapy and drugs that increase the volume of circulating blood. The antidote of Digoxin is Uniothiol.

It is important to remember that a lethal outcome is possible with an overdose.

special instructions

During the treatment with Digoxin, the patient should be under the supervision of a physician in order to avoid the development of side effects. Patients receiving digitalis preparations should not prescribe calcium preparations for parenteral administration.

It is necessary to reduce the dose of Digoxin to patients with chronic "pulmonary" heart, coronary insufficiency, violations of water-electrolyte balance, kidney or liver failure. Older patients also require careful dose selection, especially if they have one or more of the above conditions. Thus it is necessary to consider, that at these patients even at disturbance of function of kidneys values of a clearance of a creatinine (CC) may be within normal limits, which is associated with a decrease in muscle mass and a decrease in the synthesis of creatinine. Since in renal failure pharmacokinetic processes are violated, the dose selection should be carried out under the control of serum digoxin concentration. If this is not feasible, the following recommendations can be used: in general, the dose should be reduced by approximately the same percentage as the creatinine clearance is reduced. If QC was not determined, then it can be approximately calculated based on the serum creatinine concentration (CCS). For men according to the formula (140 - age) / KKS. For women, the result should be multiplied by 0.85. In severe renal failure (CC less than 15 ml / min.), The serum concentration of digoxin should be determined every 2 weeks, at least during the initial treatment period.

With idiopathic subaortic stenosis (obstruction of the left ventricular outflow tract by asymmetrically hypertrophic interventricular septum) the appointment of Digoxin leads to an increase in the severity of obstruction.

With severe mitral stenosis and normo- or bradycardia, heart failure develops as a result of a decrease in the diastolic filling of the left ventricle. Digoxin, increasing myocardial contractility of the right ventricle, causes a further increase in pressure in the system pulmonary artery, which can provoke pulmonary edema or aggravate left ventricular failure. Patients with mitral stenosis are assigned cardiac glycosides upon adherence to right ventricular failure, or in the presence of atrial tachyarrhythmia.

In patients with AV blockade II degree, the appointment of cardiac glycosides can aggravate it and lead to the development of the attack of Morgagni-Adams-Stokes. The appointment of cardiac glycosides with AV blockade of the first degree requires caution, frequent monitoring of the ECG, and in some cases - pharmacological prophylaxis with agents that improve AV conduction.

Digoxin in Wolff-Parkinson-White syndrome, slowing AV conduction, facilitates impulses through additional ways of conducting around the AV node and, thereby, provokes the development of paroxysmal tachycardia.

The likelihood of occurrence of glycosidic intoxication increases with hypokalemia, hypomagnesemia, hypercalcemia, hypernatremia, hypothyroidism, marked dilatation of the heart cavities, "pulmonary" heart, myocarditis and in the elderly. Monitoring of their plasma concentration is used as one of the methods of controlling digitalization in the appointment of cardiac glycosides.

Cross-sensitivity

Allergic reactions to digoxin and other medicines of digitalis develop rarely. If there is an increased sensitivity to any one medicine digitalis, other representatives this group can be used, since the cross-sensitivity to digitalis preparations is not peculiar.

The patient must strictly follow the following instructions:

apply the drug only as prescribed, do not change the dose alone;
every day apply the drug only at the appointed time;
if the heart rate is less than 60 beats per minute, you should immediately consult a doctor;
if the next dose of the drug is missed, it must be taken as soon as possible;
Do not increase or double the dose;
If the patient did not take the drug for more than 2 days, this should be reported to the doctor.

Before stopping the use of the drug, you should inform the doctor about it. When there is vomiting, nausea, diarrhea, rapid pulse, you should immediately consult a doctor.

Before surgery or when providing emergency care, the doctor should be warned about the use of Digoxin.

Without the permission of the doctor, the use of other medicinal products is undesirable. The preparation contains sucrose, lactose, potato starch, glucose in an amount corresponding to 0.006 bread units.

Drug Interactions

When combined with reserpine, phenytoin, propranolol, the risk of arrhythmia increases.
Decrease the concentration in the blood of digoxin phenylbutazone and preparations of the barbituric series (as a consequence, its effectiveness decreases).
Reduce the therapeutic effect of antacids, potassium, metoclopramide and neomycin.
When combined with gentamycin, erythromycin, the concentration of the drug in the blood plasma increases.
Incompatible with the salts of metals, acids, alkalis and tannins. When combined with diuretics, glucocorticosteroids, insulin, sympathomimetics, preparations of calcium salts, the likelihood of developing glycosidic intoxication increases.
In combination with quinidine, erythromycin, with amiodarone, verapamil, an increase in the concentration of the drug in the blood is observed. Quinidine reduces the excretion of digoxin, which increases its content in the blood.
In combination with amphotericin B, the risk of overdose increases due to the fact that amphotericin B causes hypokalemia. An increase in serum calcium concentration increases the sensitivity of the heart muscle, so calcium preparations should not be administered intravenously to patients taking cardiac glycosides.
Simultaneous reception with cholestyramine, cholestipol, magnesium laxatives, antacids, metoclopramide absorption digoxin from the gastrointestinal tract decreases (there is a decrease in the concentration of digoxin in the blood).
Metabolism of the drug is enhanced when combined with sulfosalazine and rifampicin, as a consequence, a decrease in the concentration of digoxin in the blood plasma.
Renal clearance of digoxin may decrease with simultaneous administration of verapamil. However, this effect is reduced with prolonged use of both drugs (5-6 weeks). Both verapamil and quinidine can displace digoxin from the binding sites, so at the beginning of treatment, a sharp increase in the concentration of digoxin in the blood plasma is possible. With continued use, the concentration of the drug stabilizes at a level that depends on the clearance of the digitalis.

Reviews

We picked up some of the people's comments about Digoxin:

Vadim. Very serious drug. In case of an overdose, all of the described side effects appear. In small doses it helps. Overdo it - kills.
Zhenya. My grandmother regularly took digoxin. She had heart problems, suffered from arrhythmias and tachycardia. I tried many different pills, but eventually everything stopped working. A digoxin is excellent, but you need to take it constantly, so that the concentration of the drug in the blood. A good drug and, most importantly, inexpensive. Do not forget to consult a doctor, since digoxin may not be suitable for you or cause some side effects.
Sergei. Digoxin to my mother was prescribed by a cardiologist. After 2 weeks, the pulse was restored, the flickering arrhythmia passed. I switched to maintenance, every morning 1TB 0.25 - Hungarian, a week ago bought our - the domestic said the same thing, only the producer of another and then started: through week pulse 118, flickering arrhythmia, racked his brains before the explosion, went to buy Hungarian, so as not to jinx - the pulse began to recover and the arrhythmia does not show. It is a pity that I threw out the packaging. Domestic in the plates, and Hungary in the bank - so be more careful.

Analogues

Preparations similar in mechanism of action, digoxin analogues: Digitoxin, Cordigit, Medilzide, Celanide, Lanatozide.

Before using analogues, consult your doctor.

Storage conditions and shelf life

Shelf life of the tablets Digoxin is 3 years from the time of their manufacture. The drug should be stored in a dark, dry place at an air temperature ranging from +15 to + 25 ° C. Keep away from children.