Known brand names include Lanoxin and Digox.
A cardiac glycoside that makes the heart pump more strongly and slows the heart rate. It treats mild to moderate heart failure and controls the heart rate in chronic atrial fibrillation. The gap between helpful and toxic levels is narrow.
Oral digoxin is not on the ISMP acute care list. IV inotropic medications, including IV digoxin, are on it.
Sources: [1]
Narrow therapeutic index. The label states that digoxin has a narrow therapeutic index. Serum levels below 0.5 ng/mL are linked to reduced efficacy and levels above 2 ng/mL to toxicity.
None on the current Lanoxin label. Digoxin toxicity is a labeled warning instead.
Sources: [1]
Digoxin immune Fab (DigiFab) for life-threatening arrhythmias, high-grade AV block, or hyperkalemia; it is 80% to 90% effective. Stop digoxin and place on a cardiac monitor. Correct low potassium (keep 4.0 to 5.5 mmol/L) and magnesium, but avoid potassium with bradycardia or heart block. Atropine or pacing for bradycardia. Give activated charcoal after a large ingestion. Dialysis does not remove digoxin.
Sources: [1]
Doses come from the FDA label. Study tool, not for clinical decisions.
Required. Digoxin is mainly cleared by the kidneys, so lower maintenance doses are needed as creatinine clearance falls (see the label's dose tables). Half-life lengthens, steady state takes longer, and toxicity lasts longer. It is prolonged to 3.5 to 5 days in anuria.
Inhibits the sodium-potassium ATPase pump, which raises calcium inside heart cells and strengthens contraction. It also boosts vagal tone, which slows the sinus rate and AV node conduction. Oral onset is 0.5 to 2 hours, with peak effect in 2 to 6 hours; half-life is 1.5 to 2 days with normal kidneys.