Digoxin
- Atc Codes:C01AA05
- CAS Codes:20830-75-5
- PHARMGKB ID:20830-75-5
Table of contents
- Brand Names
- Chemistry
- Pharmacologic Category
- Mechanism of Action
- Therapeutic Use
- Pregnancy and Lactation Implications
- Contraindications
- Warnings and Precautions
- Adverse Reactions
- Toxicological Effects
- Caution and personalized dose adjustment in patients with the following genotypes
- Other genes that may be involved
- Substrate of
- Drug Interactions
- Nutrition/Nutraceutical Interactions
- Dosage
- Pharmacokinetics and Pharmacodynamics
- Special Considerations
Brand Names
Europe
Belgium: Lanoxin; Bulgaria: Digoxin, Dilacor; Cyprus: Lanoxin; Czech Republic: Digoxin; Denmark: Digoxin; Estonia: Digoxin; Finland: Digoxin; France: Digoxine, Hemigoxine; Germany: Digacin, Digoxin, Lanicor, Lenoxin, Ricrat-Digo; Greece: Digibind, Digoxin, Digoxine, Lanoxin; Hungary: Digoxin; Ireland: Lanoxin; Italy: Digoss, Eudigox, Lanoxin; Latvia: Digoxicor, Digoxin; Lithuania: Digoxin; Luxembourg: Digoxine, Lanicor, Lanoxin; Malta: Digibind, Lanoxin; Netherlands: Lanoxin; Poland: Digoxin; Portugal: Lanoxin; Romania: Digoxin, Lanoxin; Slovakia: Digoxin; Spain: Digoxina, Lanacordin; Sweden: Digoxin, Lanoxin; UK: Digibind, Digoxin, Lanoxin.
North America
Canada: Digoxin, Digibind, Lanoxin, Toloxin; USA: Digoxin, Lanoxicaps, Lanoxin.
Latin America
Argentina: Cardiogoxin, Digocard-G, Digoxina, Lanicor, Lanoxin; Brazil: Cardcor, Cardionil, Cimecard, Digitax, Digobal, Digoxen, Digoxil, Digoxin, Digoxina, Valoxin-Sanval; Mexico: Bioxalyt, Lanoxin, Mapluxin, Valvulan.
Asia
Japan: Digohan, Digosin, Halfdigoxin KY.
Drug combinations
Chemistry
Digoxin: C~41~H~64~O~14~. Mw: 780.94. (1) Card-20(22)-enolide, 3-[(O-2,6-dideoxy-β-D-ribo-hexopyranosyl-(1→4)-O-2,6-dideoxy-β-D-ribo-hexopyranosyl-(1→4)-2,6-dideoxy-β-D-ribo-hexopyranosyl)oxy]-12,14-dihydroxy-, (3β,5β,12β)-; (2) 3β-[(O-2,6-Dideoxy-β-D-ribo-hexopyranosyl-(1→4)-O-2,6-dideoxy-β-D-ribo-hexopyranosyl-(1→4)-2,6-dideoxy-β-D-ribo-hexopyranosyl)oxy]-12β,14-dihydroxy-5β-card-20(22)-enolide. CAS-20830-75-5.
Pharmacologic Category
Cardiac Drugs; Cardiotonic Agents. Cardiac Glycoside. (ATC-Code: C01AA05).
Mechanism of action
Digoxin is a cardiac glycoside with positive inotropic effects. In congestive heart failure it inhibits the sodium/potassium ATPase pump which acts to increase the intracellular sodium-calcium exchange to increase intracellular calcium, leading to increased contractility. In supraventricular arrhythmias: Direct suppression of the AV node conduction to increase effective refractory period and decrease conduction velocity; positive inotropic effect, enhanced vagal tone, and decreased ventricular rate to fast atrial arrhythmias. Atrial fibrillation may decrease sensitivity and increase tolerance to higher serum digoxin concentrations.
Therapeutic use
Digitalization and maintenance therapy. Used principally in the prophylactic management and treatment of congestive heart failure and to control the ventricular rate in supraventricular tachyarrhythmias (e.g. atrial fibrillation or flutter). Used to improve left ventricular function in cardiogenic shock and atrial fibrillation or flutter with rapid ventricular rate. May be useful, especially in conjunction with a β-adrenergic blocking agent, in the treatment of angina pectoris when cardiomegaly and congestive heart failure are present.
Pregnancy and lactiation implications
Use caution when administering to pregnant or nursing women.
Unlabeled use
Contraindications
Hypersensitivity to digoxin or any component of the formulation. Hypersensitivity to cardiac glycosides. History of toxicity. Ventricular tachycardia or fibrillation. Idiopathic hypertrophic subaortic stenosis. Constrictive pericarditis. Amyloid disease. Second- or third-degree heart block (except in patients with a functioning artificial pacemaker). Wolff-Parkinson-White syndrome and atrial fibrillation concurrently.
Warnings and precautions
Proarrhythmic effects might occur. Use with caution in acute MI within 6 months. Electrolyte disturbances, especially hypokalemia or hypomagnesemia, should be corrected prior to use and throughout therapy. Withdrawal in heart failure may lead to recurrence of heart failure symptoms. Atrial arrhythmias associated with hypermetabolic states are very difficult to treat. Use with caution in renal impairment. Use with caution in sinus nodal disease (may worsen) or in incomplete AV block (especially with Adams-Stokes attacks). When amiodarone, quinidine, or verapamil are added to a patient on digoxin, dose should be adjusted. Calcium can produce serious arrhythmias in digitalized patients (especially when administered rapidly I.V.). Antiarrhythmic agents should be reserved for life-threatening ventricular arrhythmias. Reduce or hold dose 1-2 days before elective electrical cardioversion in atrial fibrillation.