General High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error. **BEERS Drug** Pronunciation: Trade Name(s) Ther. Class. antiarrhythmics inotropics Pharm. Class. digitalis glycosides Action Therapeutic Effect(s): Increased cardiac output (positive inotropic effect)
and slowing of the heart rate (negative chronotropic effect). Absorption: 60–80% absorbed after oral administration of tablets; 70–85% absorbed after administration of elixir; 80% absorbed from IM sites (IM route not recommended due to pain/irritation). Distribution: Widely distributed; crosses placenta and enters breast milk. Metabolism and Excretion: Excreted almost entirely
unchanged by the kidneys. Half-life: 36–48 hr (↑ in renal impairment). TIME/ACTION PROFILE (antiarrhythmic or inotropic effects, provided that a loading dose has been given)
Contraindication/PrecautionsContraindicated in:
Use Cautiously in:
Adverse Reactions/Side EffectsCV: ARRHYTHMIAS, bradycardia, ECG changes, AV block, SA block EENT: blurred vision, yellow or green vision GI: anorexia, nausea, vomiting, diarrhea Hemat: thrombocytopenia Metabolic: electrolyte imbalances with acute digoxin toxicity Neuro: fatigue, headache, weakness. * CAPITALS indicate life-threatening. InteractionsDrug-Drug
Drug-Natural Products:
Drug-Food: Concurrent ingestion of a high-fiber meal may ↓ absorption. Administer digoxin 1 hr before or 2 hrs after such a meal. Route/DosageFor rapid effect, a larger initial loading/digitalizing dose should be given in several divided doses over 12–24 hr. Maintenance doses are determined for digoxin by renal function. All dosing must be evaluated by individual response. In general, doses required for atrial arrhythmias are higher than those for inotropic effect. IV IM (Adults): Digitalizing dose– 0.5–1 mg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 6–12 hr intervals. IV IM (Children >10 yr): Digitalizing dose– 8–12 mcg/kg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 6–12 hr intervals. IV IM (Children 5–10 yr): Digitalizing dose– 15–30 mcg/kg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 6–12 hr intervals. IV IM (Children 2–5 yr): Digitalizing dose– 25–35 mcg/kg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 6–12 hr intervals. IV IM (Children 1–24 mo): Digitalizing dose– 30–50 mcg/kg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 6–12 hr intervals. IV IM (Infants –full term): 20–30 mcg/kg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 6–12 hr intervals. IV IM (Infants –premature): Digitalizing dose– 15–25 mcg/kg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 6–12 hr intervals. PO (Adults): Digitalizing dose– 0.75–1.5 mg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 6–12 hr intervals. Maintenance dose– 0.125–0.5 mg/day depending on patient's lean body weight, renal function, and serum level. PO Geriatric Patients: Initial daily dose should not exceed 0.125 mg. PO (Children >10 yr): Digitalizing dose– 10–15 mcg/kg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 6–12 hr intervals. Maintenance dose– 2.5–5 mcg/kg given daily as a single dose. PO (Children 5–10 yr): Digitalizing dose– 20–35 mcg/kg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 6–12 hr intervals. Maintenance dose– 5–10 mcg/kg given daily in 2 divided doses. PO (Children 2–5 yr): Digitalizing dose– 30–40 mcg/kg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 6–12 hr intervals. Maintenance dose– 7.5–10 mcg/kg given daily in 2 divided doses. PO (Children 1–24 mo): Digitalizing dose– 35–60 mcg/kg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 6–12 hr intervals. Maintenance dose– 10–15 mcg/kg given daily in 2 divided doses. PO (Infants –full term): Digitalizing dose– 25–35 mcg/kg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 6–12 hr intervals. Maintenance dose– 6–10 mcg/kg given daily in 2 divided doses. PO (Infants –premature): Digitalizing dose– 20–30 mcg/kg given as 50% of the dose initially and one quarter of the initial dose in each of 2 subsequent doses at 6–12 hr intervals. Maintenance dose– 5–7.5 mcg/kg given daily in 2 divided doses. Availability (generic available)Elixir (lime flavor): 0.05 mg/mL Cost: Generic: $42.10/60 mL Solution for injection: 0.25 mg/mL Solution for injection (pediatric): 0.1 mg/mL Tablets: 0.0625 mg, 0.125 mg, 0.25 mg Cost: Generic: All strengths $27.75/10 Assessment
Lab Test Considerations: Evaluate serum electrolyte levels (especially potassium, magnesium, and calcium) and renal and hepatic function periodically during therapy. Notify health care professional before giving dose if patient is hypokalemic. Hypokalemia, hypomagnesemia, or hypercalcemia may make the patient more susceptible to digitalis toxicity. Pedi: Neonates may have falsely elevated serum digoxin concentrations due to a naturally occurring substance chemically similar to digoxin. Toxicity and Overdose: Therapeutic serum digoxin levels range from 0.5–2 ng/mL. Serum levels may be drawn 6–8 hr after a dose is administered; usually drawn immediately before the next dose. Geri: Older adults are at increased risk for toxic effects of digoxin (on Beers list) due to age-related decreased renal clearance; may exist even when serum creatinine levels are normal. Digoxin requirements in older adult may change and a formerly therapeutic dose can become toxic.
Potential Diagnoses
Implementation
IV Administration
Patient/Family Teaching
Evaluation/Desired Outcomes
digoxin is a sample topic from the Davis's Drug Guide. To view other topics, please log in or purchase a subscription. Nursing Central is an award-winning, complete mobile solution for nurses and students. Look up information on diseases, tests, and procedures; then consult the database with 5,000+ drugs or refer to 65,000+ dictionary terms. Complete Product Information. What are components of pharmacokinetics does the nurse need to understand before administering a drug?The four main parameters generally examined by this field include absorption, distribution, metabolism, and excretion (ADME).
What are the three phases of drug action?A tablet or capsule taken by mouth goes through three phases—pharmaceutic, pharmacokinetic, and pharmacodynamic—as drug actions occur.
What are the phases of pharmacokinetics?Think of pharmacokinetics as a drug's journey through the body, during which it passes through four different phases: absorption, distribution, metabolism, and excretion (ADME).
Why is halfThe half-life can also be a guide for how long a drug will take to reach a stable level in your body when you first start taking it. Generally, it will take about five times the drug's half-life to build a stable level in your body.
|