Parenteral Manual


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Alternate Name(s): 
Cardiac glycoside
Original Date: 
August 2005
Revised Date: 
December 2019
  • Inotropic agent for treatment of congestive heart failure
  • Antiarrhythmic for treatment of supraventricular arrhythmias such as atrial fibrillation, atrial flutter and paroxysmal atrial tachycardia
Reconstitution and Stability: 
  • Available as 50 mcg/mL (0.05 mg/mL). Stable at room temperature. Protect from light
  • Diluted solutions stable 48 hours at room temperature or in fridge

- Solutions Compatible: dextrose up to D10W, NS, Sterile Water for Injection, ringer's lactate

- Additives/Above Cassette Compatible: furosemide

-Y-site Compatible: KCl (up to 40 mmol/mL), morphine, TPN (amino acids/dextrose), heparin, meropenem

-Incompatible: dobutamine, propofol, fluconazole


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IM NO, very painful
IV Direct


IV Intermittent Infusion

Usual dilution: 10 mcg/mL
Infusion time: 5-10 minutes

IV Continuous Infusion NO

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

DIGITALIZING DOSE: (3 doses- 1st stat; 2nd in 6 hrs; 3rd in another 6 hrs)

  • Term infants-2 years: 12 mcg/kg/dose IV
  • >2 years: 10 mcg/kg/dose IV
  • Maximum total digitalizing dose: 1 mg

MAINTENANCE DOSE: Start 12 hours after last digitalizing dose

  • Term infants-2 years: 7 mcg/kg/day IV divided Q12H
  • >2-10 years: 6 mcg/kg/day IV once daily or divided Q12H
  • >10 years: 2-3 mcg/kg/day IV once daily
  • Maximum maintenance dose: 250 mcg/day

- Total digitalizing dose: reduce by 50% in end-stage renal disease
- Maintenance dose:

  • CrCl 10-50 mL/min: Administer 25-75% of normal daily dose (divided and given at normal intervals) or administer normal dose every 36 hours
  • CrCl < 10 mL/min: Administer 10-25% of normal daily dose (divided and given at normal intervals) or administer normal dose every 48 hours
Potential hazards of parenteral administration: 
  • IM injections may cause pain and muscle spasm, erratic absorption and crystal deposition in the muscle    
  • Extravasation may cause local irritation and sloughing                  
  • Non-cardiac symptoms of digoxin toxicity hard to evaluate in children; usual toxic effects reported in infants are:
    Gastrointestinal: feeding intolerance/diminished appetite, persistent vomiting
    - Cardiac effects: the diagnosis of digoxin toxicity in neonates and infants usually 
    rests on ECG abnormalities, arrhythmias, first degree AV block, PVC's, bigeminy
    PAT with block; sinus node bradycardia is the major cardiac manifestation in low
    birth weight infants.
  • Monitor heart rate and rhythm, serum potassium, magnesium, calcium, ECG
  • IV dose = oral dose × 0.7
  • Oral dose = IV dose × 1.4

Treatment of overdose:

  • Discontinue drug
  • Administer potassium salts and other cardiac drugs for treating arrhythmias
  • Possibility of digitalis toxicity greater in patients who are hypokalemic, hypo or hypermagnesemic, hypercalcemic, have decreased renal function, are in premature age category, had a loading dose
  • DIGIBIND may be used as an antidote.  One vial of Digibind neutralizes 0.5 mg digoxin.

Drug levels:

  • Therapy should be monitored by clinical effect rather than serum level; useful when toxicity suspected
  • "Therapeutic" serum level 1.3-2.7 nmol/L (correlation with therapeutic effect not clearly defined)
  • Draw blood for digoxin at least 8 hrs post dose or preferably prior to next scheduled dose
  • Levels may be elevated in neonates due to endogenous digoxin-like substances
  • When administering digoxin, nurses first take the heart rate.  If the heart rate is lower than indicated below, the medication is held and the physician is notified:


    Heart Rate

    Birth- 6 months

    95 beats/minute

    6 months-18 months

    80 beats/minute

    >18 months

    65 beats/minute


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