Alternate Name(s):
Lanoxin
Classification:
Inotrope/Antiarrhythmic
Original Date:
March 1992
Revised Date:
August 2026
Indications:
- Heart failure
- Arrhythmias: supraventricular tachycardia, atrial flutter, atrial fibrillation
Administration:
- IV direct: over 3 - 5 minutes
- PO
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: 2.5-3.75 mcg/kg/dose Q12H
- IV: 2-3 mcg/kg/dose Q12H
- Full-term:
- PO:3- 5 mcg/kg/dose Q12H
- IV: 2.5-4 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.
Digoxin Antidote dosing (Digoxin Immune Fab): refer to Lexi-Drugs Database
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 IV: 10 mcg/mL syringe prepared by pharmacy
- Withdraw 0.5 mL of digoxin 250 mcg/mL from ampule
- Add to 12 mL of NaCL 0.9%
- Final Concentration: 10 mcg/mL
Antidote to digoxin: Digoxin Immune Fab
- Reconstitute 40 mg vial with 4 mL SWFI to produce a 10 mg/mL solution. For doses less than 3 mg, further dilute to a concentration of 1 mg/mL in 0.9% NaCL
- Stable 30 minutes at room temperature once mixed
- Administer over 15-30 minutes
Compatibility:
- Solutions Compatible: D5W, 0.9% NaCl
- Y-site Compatible: heparin, KCl (up to 40 mmol/L), morphine, TPN
Incompatible: dobutamine, fluconazole
Notes:
- HIGH ALERT MEDICATION
- Significant interactions exist: ensure to consult pharmacy
- The use in conjunction with amiodarone requires dose reduction
- Antidote: digoxin immune fab
References:
- Lexi-Comp Online Database
- Batra AS, Silka MJ, Borquez A, Cuneo B, Dechert B, Jaeggi E, Kannankeril PJ, Tabulov C, Tisdale JE, Wolfe D; American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology, Council on Basic Cardiovascular Sciences, Council on Cardiovascular and Stroke Nursing, Council on Genomic and Precision Medicine, and Council on Lifelong Congenital Heart Disease and Heart Health in the Young. Pharmacological Management of Cardiac Arrhythmias in the Fetal and Neonatal Periods: A Scientific Statement From the American Heart Association: Endorsed by the Pediatric & Congenital Electrophysiology Society (PACES). Circulation. 2024 Mar 5;149(10):e937-e952.