Digoxin
Digoxin is a medication belonging to the class of cardiac glycosides. It is derived from the foxglove plant (Digitalis purpurea) and is used to treat various heart conditions by affecting the heart's contractions. It has direct effects on myocardial contractility and electrophysiological conduction properties i.e. 1. Negative chronotropic effect (Reduces heart rate & A.V. conduction). 2. Positive inotropic effect i.e. there is a dose dependent increase in force of contraction of myocardium. The above two effects thereby make it an ideal drug for treatment of cardiac failure of diverse aetiologies without increasing the oxygen demand of the failing myocardium. There is also a mild direct vasoconstrictor action thereby increasing peripheral resistance mildly. Diuresis is seen promptly in C.H.F. patients owing to improved renal perfusion which was previously compromised but at times an addition of diuretic may be considered to improve the patients hypoxic and hypervolemic condition rapidly if need arises.-Congestive heart failure -Atrial fibrillation -Atrial flutter -Supraventricular tachycardia -Congestive heart failure, cardiac tachyarrhythmias (Paroxysmal supraventricular tachycardia, atrial flutter & fibrillation).
-The dosage of digoxin is individualized based on the patient's age, weight, renal function, and specific heart condition. It is typically administered orally, with regular monitoring of blood levels to ensure therapeutic effectiveness. -Initially 0.25-1.5 mg daily. Maint; 0.25-0.5 mg daily Children : initially 10-20 mcg/kg body wt. 6 hrly. Maint 10-20 mcg/kg body wt. in single or divided doses daily.
-Hypersensitivity to digoxin -Ventricular fibrillation -Heart block (unless a pacemaker is present) -Uncontrolled ventricular arrhythmias -Hypokalemia, ventricular tachycardia, partial A.V. block, acute myocarditis. Wolf-Parkinson-White Syndrome.
-Renal impairment -Electrolyte imbalances (particularly low potassium levels) -Hypothyroidism -Elderly patients -Pregnant or breastfeeding women Elderly, renal or severe hepatic disease, myocardial infarction, thyrotoxicosis, calcium synergises to precipitate toxicity. Paediatrics: reduce dose necessary. Pregnancy: No evidence of risk. Lactation: Present in breast milk hence use only if indicated.
-Common side effects may include nausea, vomiting, loss of appetite, and visual disturbances. Serious side effects such as arrhythmias, confusion, and allergic reactions are rare but should be reported to a healthcare provider. -Anorexia, nausea, vomiting, abdominal pain, fatigue, headache, mental confusion, restlessness.
Digoxin may interact with various medications, including but not limited to: -Diuretics -Beta-blockers -Calcium channel blockers -Quinidine -Amiodarone -Some antibiotics -Diuretics causes hypokalemia and precipitate digitalis toxicity. Blood levels increased by calcium channel blockers, spironolactone, quinidine and calcium salts. Metoclopromide interferes with absorption of solid dosage form of digoxin. Antacids reduces digoxin absorption.
