Description

Simple

A heart medication used to treat mild to moderate heart failure and abnormal heart rhythms in a disease called atrial fibrillation.

Clinical

A cardiac glycoside used in the treatment of mild to moderate heart failure and for ventricular response rate control in chronic atrial fibrillation.

Overview

Digoxin is one of the oldest cardiovascular medications used today.[5] It is a common agent used to manage atrial fibrillation and the symptoms of heart failure.[7] Digoxin is classified as a cardiac glycoside and was initially approved by the FDA in 1954.[25]

This drug originates from the foxglove plant, also known as the _Digitalis_ plant[21], studied by William Withering, an English physician and botanist in the 1780s.[8,Read more

Pharmacology

Indication

Digoxin is indicated in the following conditions: 1) For the treatment of mild to moderate heart failure in adult patients.[25] 2) To increase myocardial contraction in children di... Read more

Pharmacodynamic

Digoxin is a positive inotropic and negative chronotropic drug[7], meaning that it increas... Read more

Mechanism of action

Digoxin exerts hemodynamic, electrophysiologic, and neurohormonal effects on the cardiovascular system.[ Read more

Absorption

Digoxin is approximately 70-80% absorbed in the first part of the small bowel.[6] The bioavailability of... Read more

Protein binding

Digoxin protein binding is approximately 25%.[25] It is mainly bound to albumin.[ Read more

Volume of distribution

This drug is widely distributed in the body, and is known to cross the blood-brain barrier and the placenta.[25, Read more

Clearance

The clearance of digoxin closely correlates to creatinine clearance, and does not depend on urinary flow. Individuals with renal impairment or failure may exhibit extensively prolonged half-lives. It is therefore important to titrate the dose accordingly and regularly monitor serum digoxin levels.[ Read more

Half life

Digoxin has a half-life of 1.5-2 days in healthy subjects.[25] The half-life in patients who do not pass urine, usually due to renal failure, is prolonged to 3.5-5 days. Since mos... Read more

Route of elimination

The elimination of digoxin is proportional to the total dose, following first order kinetics. After intravenous (IV) administration to healthy subjects, 50-70% of the dose is measured excreted as unchanged digoxin in the urine. Approximately 25 to 28% of digoxin is eliminated outside of the kidney.... Read more

Toxicity

Oral TDLO (human female): 100 ug/kg, Oral TDLO (human male): 75 ug/kg, Oral LD50 (rat): 28270 ug/kg[MSDS]

Digoxin toxicity can occur in cases of supratherapeutic dose ingestion or as a result of chronic overexposure.[ Read more

Adverse Effects

Effect Regions Age Groups Incidences Evidence Type
Hospitalization US
  • Kind: experimental
    • Percent: 2
  • Kind: placebo
    • Percent: 0.9
  • Clinical Trial
    Drug-induced toxicity US
  • Kind: experimental
    • Percent: 2%
  • Kind: placebo
    • Percent: 0.9%
  • Clinical Trial
    Hyperkalemia US
    Mental disturbance US
    Varying Reports
    Decreased drug effect US
    Varying Reports
    Decreased cardiac output US
    Vasoconstriction US
    Varying Reports
    Heart Ischemia US
    Sinus Bradycardia US
    Varying Reports
    Ventricular Fibrillation US
    Varying Reports
    Ventricular Tachycardia (VT) US
    Varying Reports
    Premature Ventricular Contraction US
    Varying Reports
    AV dissociation US
    Varying Reports
    Atrial Tachycardia US
    Varying Reports
    Second degree AV block US
    Varying Reports
    First-degree AV block US
    Varying Reports
    Cardiac Arrhythmia US
    Varying Reports
    Visual Disturbance US
    Varying Reports
    Nausea US
    Varying Reports
    Gynecomastia US
    Varying Reports
    Vomiting US
    Varying Reports
    Abdominal Pain US
    Varying Reports
    Intestinal ischemia US
    Varying Reports
    Hemorrhagic necrosis of the intestine US
    Varying Reports
    Headache US
    Varying Reports
    Weakness US
    Varying Reports
    Confusion US
    Varying Reports
    Dizziness US
    Varying Reports
    Apathy US
    Varying Reports
    Anxiety US
    Varying Reports
    Depression US
    Varying Reports
    Delirium US
    Varying Reports
    Hallucination US
    Varying Reports
    Thrombocytopenia US
    Varying Reports
    Maculopapular rash US
    Varying Reports
    Skin Reactions US
    Varying Reports

    Contraindications

    • Route:
      • Oral
    • Hypersensitivity:
      • true
      • Digitalis
    • Regions: US
    • Route:
      • Oral
    • Hypersensitivity:
      • true
    • Regions: US
    • Route:
      • Oral
      • Intravenous
      • Intramuscular
    • Dose Form:
      • Injection
    • Regions: US
    • Patient Conditions:
        • Name: Ventricular Fibrillation
        • Drugbank Id: DBCOND0000505

    Food Interactions

    Avoid multivalent ions. Calcium and aluminum containing products (including kaolin-pectin) may interfere with absorption) and digoxin administration must be separated by several hours.

    Avoid potassium-containing products. They may cause arrhythmias when given with digoxin.

    Avoid St. John's Wort. This drug can decrease digoxin levels.

    Do not take with bran and high fiber foods. Separate administration of bran and high fiber foods from medication by at least 2 hours.