Alternate Name(s):
Lanoxin
Classification:
Inotrope/Antiarrhythmic
Original Date:
March 1992
Indications:
- Heart failure
- Arrhythmias: supraventricular tachycardia, atrial flutter, atrial fibrillation
Administration:
- IV direct: over 3 - 5 minutes
Dosage:
TOTAL DIGITALIZING DOSE (TDD): Give ½ TDD STAT then ¼ TDD at 8 and 16 hours
- Preterm:
- PO: 30 mcg/kg/total dose
- IV: 22.5 mcg/kg/total dose
- Full-term:
- PO: 40 mcg/kg/total dose
- IV: 30 mcg/kg/total dose
MAINTENANCE DOSE: Start 12 hours after the last digitalizing dose
- Preterm:
- PO: 3.75 mcg/kg/dose Q12H
- IV: 2.8 mcg/kg/dose Q12H
- Full-term:
- PO: 5 mcg/kg/dose Q12H
- IV: 3.75 mcg/kg/dose Q12H
**IV doses are 25% less than PO doses.
Dosage adjustment required in renal impairment. Refer to available references or clinical pharmacist for dosage adjustment.
Side Effects:
- CNS: lethargy
- CVS: bradycardia, arrhythmias
- Endocrine and metabolic: hyperkalemia with acute toxicity
- GI: feeding intolerance, vomiting, diarrhea
Parameters to Monitor:
- HR, periodic ECG
- Serum potassium, magnesium and calcium closely
- Therapeutic drug levels:
- Trough (just prior to dose): 1 - 2.5 nmol/L
- May consider doing level for suspected toxicity or lack of efficacy
Reconstitution and Stability:
- Digoxin 0.05 mg/mL
- Final concentration: 0.05 mg/mL (50 mcg/mL)
Compatibility:
- Solutions Compatible: D5W, 0.9% NaCl
- Y-site Compatible: heparin, KCl (up to 40 mmol/L), morphine, TPN
Incompatible: dobutamine, fluconazole