Neonatal Drug Therapy Manual


Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Original Date: 
March 1992
  • Heart failure
  • Arrhythmias: supraventricular tachycardia, atrial flutter, atrial fibrillation
  • IV direct: over 3 - 5 minutes

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)

- Solutions Compatible: D5W, 0.9% NaCl

- Y-site Compatible: heparin, KCl (up to 40 mmol/L), morphine, TPN

Incompatible: dobutamine, fluconazole

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