Ligoxin

Management of chronic cardiac failure where the dominant problem is systolic dysfunction; supraventricular arrhythmias particularly chronic atrial flutter & fibrillation. Cardiac failure accompanied by atrial fibrillation.

Adult & childn >10 yr who have not been given cardiac glycoside w/in the preceding 2 wk Loading dose: 500-1,000 mcg IV infusion over 10-20 min depending on age, lean body wt & renal function, administered in divided doses w/ approx ½ total dose as 1st dose & further fractions at 4-8 hr interval. Maintenance dose: 0.125-0.25 mg daily; increased sensitivity to adverse effect: ≤62.5 mcg daily. Neonate, infant & childn up to 10 yr who have not been given cardiac glycoside w/in the preceding 2 wk Loading dose: 5-10 yr 25 mcg/kg over 24 hr, 2-5 yr & term neonate to 2 yr 35 mcg/kg over 24 hr, preterm neonate 1.5-2.5 kg 30 mcg/kg over 24 hr, <1.5 kg 20 mcg/kg over 24 hr. Loading dose should be given in divided doses w/ approx ½ total dose as 1st dose & further fractions at 4-8 hr interval. Neonate, infant & childn up to 10 yr who have been given cardiac glycoside w/in the preceding 2 wk Maintenance daily dose: Term neonate & childn up to 10 yr 25% of 24-hr loading dose. Preterm neonate 20% of 24-hr loading dose.

Hypersensitivity to digoxin or other digitalis glycosides. Intermittent complete heart block or 2nd degree AV block especially if there is history of Stokes-Adams attacks. Arrhythmias caused by cardiac glycoside intoxication. Supraventricular arrhythmias associated w/ accessory AV pathway as in the Wolff-Parkinson-White syndrome. Accessory pathway known or suspected to be present & no history of previous supraventricular arrhythmias. Ventricular tachycardia or fibrillation. Hypertrophic obstructive cardiomyopathy.

Not to be used in constrictive pericarditis. Not recommended to be given IM. May precipitate arrhythmias. May cause or exacerbate sinus bradycardia or cause SA block. Hypokalaemia; hypoxia, hypomagnesaemia & marked hypercalcaemia. Rapid IV inj can cause vasoconstriction producing HTN &/or reduced coronary flow. Patient w/ thyroid disease; malabsorption syndrome or GI reconstructions; beri beri heart disease; chronic congestive cardiac failure; severe resp disease. W/hold treatment 24 hr prior to cardioversion. Administration in period immediately following MI. Avoid in patients w/ heart failure associated w/ cardiac amyloidosis; myocarditis. W/drawal in patients receiving diuretics & ACE inhibitor or diuretics alone. May prolong PR interval & depression of ST segment on the ECG. May produce false +ve ST-T changes on the ECG during exercise testing. Periodically assess serum electrolytes & renal function (serum creatinine conc). May affect ability to drive & use machines. Pregnancy & lactation. Elderly.

CNS disturbances, dizziness; visual disturbances; arrhythmia, conduction disturbances, bigeminy, trigeminy, PR prolongation, sinus bradycardia; nausea, vomiting, diarrhoea; skin rashes of urticarial or scarlatiniform character which may be accompanied by pronounced eosinophilia.

May increase AV conduction time w/ β-adrenoceptor blockers. May increase sensitivity w/ agents causing hypokalaemia or intracellular K deficiency eg, diuretics, lithium salts, corticosteroids & carbenoxolone. Increased susceptibility to effects of suxamethonium-exacerbated hyperkalaemia. May produce serious arrhythmias w/ Ca (particularly if rapidly administered IV). Serum levels may be increased w/ alprazolam, amiodarone, flecainide, gentamicin, indomethacin, itraconazole, prazosin, propafenone, quinidine, quinine, spironolactone, macrolide antibiotics (eg, erythromycin & clarithromycin), tetracycline (& possibly other antibiotics), trimethoprim, propantheline, atorvastatin, ciclosporin, epoprostenol & carvedilol. Serum levels may be reduced w/ epinephrine, antacids, kaolin-pectin, some bulk laxatives & cytostatics, colestyramine, acarbose, salbutamol, sulfasalazine, neomycin, rifampicin, phenytoin, metoclopramide, penicillamine & St. John's wort. Ca channel blocking agents & nifedipine & diltiazem may increase or cause no change in serum levels. Increased serum levels w/ verapamil, felodipine & tiapamil. ACE inhibitors may increase or cause no change in serum conc. Blood conc may be increased w/ P-gp inhibitors.

Cardiac Drugs

C01AA05 - digoxin ; Belongs to the class of digitalis glycosides. Used in the treatment of heart failure.

Rx