Digoxin tabs 0.25mg #56

Digoxin user manual

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Composition

In 1 tablet contains 0.25 mg of active ingredient digoxin.
In 1 ml of the solution contains active substance in an amount of 0.25 mg.
Additional elements are: glycerol, ethanol, sodium phosphate, citric acid, injection water.

Release form Digoxin

It is available as a solution for injection and in tablet form.

pharmachologic effect

Cardiac glycoside.

Pharmacodynamics and pharmacokinetics

Consider the mechanism of action of the drug.
The preparation of plant origin, digoxin is obtained from a woolly digitalis (Digitalis). Has a pronounced cardiotonic effect (a positive inotropic effect, an increase in the contractility of the cardiac muscle due to an increase in the concentration of calcium ions in cardiomyocytes), thereby increasing the shock volume of blood and minute volume. Reduces the need for myocardial cells in oxygen.
In addition, it has a negative dromotropic and negative chronotropic effect, that is, it reduces the frequency of generation of an electric pulse by the sinus node and the rate of impulse conduction through the atrioventricular conduction system of the heart. It also has an indirect effect on the aortic arch receptors and increases the activity of the vagus nerve, which also slows the activity of the sinoatrial node.
Thanks to these mechanisms, it is possible to achieve a reduction in heart rate in supraventricular tachyarrhythmias (paroxysmal or permanent forms of atrial tachyarrhythmias, atrial flutter).
With severe heart failure and signs of stagnation over large and small circles of circulation, the drug has an indirect vasodilatation effect, which is manifested in a decrease in the overall resistance of the peripheral vascular bed and a decrease in the degree of dyspnea and peripheral edema.
It is taken orally, 70% of the active substance is absorbed into the digestive tract, after intake the limiting concentration is reached in the interval from two to 6 hours. The parallel intake of food leads to a certain increase in the time of absorption. Exceptions are products rich in plant fiber - in this case part of the active substance is adsorbed by dietary fiber and becomes inaccessible.
It has the property of accumulating in liquids and tissues, including the myocardium, which is used in determining the scheme of application: the effect of the drug is calculated not by the maximum concentration of the substance in the plasma, but by the content at the moment of the equilibrium state of the pharmacokinetics.
50-70% of the drugs are excreted by the kidneys, a severe pathology of this organ can promote the accumulation of digoxin in the body. The half-life period reaches two days.

Indications for use Digoxin

What do tablets and solutions usually use?

Indications for the use of digoxin are cardiac arrhythmia (arrhythmia) of supraventricular character (paroxysmal ciliary tachyarrhythmia, atrial flutter, constant ciliary tachyarrhythmia).
The medication is included in the treatment regimens of chronic heart failure of the third and fourth functional class, and also is used for CHF of the second class if the expressed clinical manifestations are diagnosed.

Contraindications

Direct contraindications for the prescription of the drug are signs of glycosidic intoxication, hypersensitivity to digoxin, Wolff-Parkinson-White syndrome, second-degree atrioventricular block and full atrioventricular block, bradycardia.
You can not prescribe medication for such manifestations of coronary heart disease as unstable angina and acute period of myocardial infarction.
Contraindicated drug with isolated mitral stenosis.
Heart failure of the diastolic type (with cardiac tamponade, with constrictive pericarditis, with amyloidosis of the heart, with cardiomyopathy) is also a contraindication to the appointment of Digoxin.
The pronounced dilatation of the heart, obesity, kidney failure and hepatic parenchyma, myocardial inflammation, interventricular septum hypertrophy, subaortic stenosis, ventricular tachyarrhythmias - under these conditions, the use of the drug is unacceptable.

Side effects

First of all, you need to pay attention to possible side effects from the cardiovascular system, since they can be the first signs of developing glycoside intoxication.
Such symptoms include slowing of atrioventricular conduction and, as a consequence, slowing of the rhythm (bradycardia), the appearance of heterotrophic foci of myocardial excitation, manifested in the development of ventricular arrhythmia (extrasystole) and ventricular fibrillation.
Unintended side effects do not represent, in contrast to intracardiac, the threat to the life of the patient. These include signs of a violation of the function of the digestive tract (nausea, pain in the stomach, vomiting and diarrhea), the nervous system (headaches, depression or psychosis, disruption of the visual analyzer in the form of flies before the eyes, etc.).
On the part of the blood there may be a violation of the morphological picture in the form of thrombocytopenia, and it will be manifested as petechiae on the skin.
Perhaps the development of allergic reactions to digoxin in the form of erythema skin, itching and rash.

Instructions for use Digoxin (Method and dosage)

The inclusion of a drug in treatment regimens should be made exclusively in a hospital setting. Therapeutic window Digoxin (the interval between the therapeutic dose and toxic) is very small, and therefore, all recommendations for taking the medicine must be observed scrupulously.

Tablets Digoxin, instructions for use

At the first stage of treatment (the stage of digitalization, or saturation of the patient's body with the drug), the drug is prescribed in a dosage, which is usually called saturable: the patient takes from two to four tablets (which is 500 micrograms - one milligram), after which one tablet with an interval of 6 hours. This continues until a therapeutic effect is obtained, and a stable concentration of digoxin in the blood is reached within seven days.
The next step is to regularly take a maintenance dose of the drug, which is usually half a tablet or one tablet per day (one tablet of Digoxin contains 250 micrograms of the active substance). Do not skip the medication, nor can you take a double dose in a single dose when you miss a drug. This is fraught with the development of intoxication, which can result in a fatal outcome.
In cardiology units and in the department of cardiac recovery medication is prescribed and intravenously for the purpose of arresting supraventricular paroxysmal tachyarrhythmias.

Overdose

Symptoms of an overdose (glycosidic intoxication): the heart rate slows down, a sinus bradycardia appears. On the electrocardiogram, there are signs of slowing atrioventricular conduction, up to a complete atrioventricular block. Heterotrophic sources of rhythm give ventricular extrasystoles, ventricular fibrillation is possible. Intrinsic symptoms of glycoside intoxication are manifested by dyspepsia (nausea, diarrhea, anorexia), memory and cognitive impairment, drowsiness, headaches, muscle weakness, erectile dysfunction, gynecomastia, psychosis, anxiety, euphoria, xanthopia, decreased visual acuity and other impairments. the work of the visual analyzer.
In the case of signs of glycoside intoxication, the tactics depend on the severity of the manifestations: it is enough to reduce the dose of Digoxin with minor overdoses. If there is a progression of side effects, it is worth taking a short break, the duration of which depends on the dynamics of signs of intoxication. Acute poisoning Digoxin requires washing the stomach, taking sorbents in large quantities. The patient is given a laxative.
Ventricular arrhythmias can be eliminated by intravenous administration of potassium chloride with the addition of insulin. Potassium preparations can not be categorically prescribed for slowing the atrioventricular conduction. When the arrhythmia is maintained, intravenous phenytoin is administered. Atropine is used to treat bradycardia. In parallel, they are prescribed oxygen therapy and drugs that increase the volume of circulating blood. The antidote of Digoxin is Uniothiol.
It is important to remember that a lethal outcome is possible with an overdose.

Interaction

The medicine can not be combined with alkalis, with acids, with salts of heavy metals and with tannins. When used together with diuretics, insulin, preparations of calcium salts, sympathomimetics, glucocorticosteroids, the risk of symptoms of glycosidic intoxication increases.
In combination with quinidine, amiodarone and erythromycin, there is an increase in the digoxin content in the blood. Quinidine inhibits the excretion of the active substance. Calcium channel blocker Verapamil reduces the rate of elimination of digoxin from the body by the kidneys, which leads to an increase in the concentration of cardiac glycoside. This action of verapamil is gradually leveled by prolonged joint intake of drugs (more than six weeks).
Combination with amphotericin B increases the likelihood of an overdose of glycosides due to hypokalemia, which is provoked by amphotericin B. Hypercalcemia increases the susceptibility of cardiomyocytes to cardiac glycosides, and therefore, intravenous administration of calcium preparations should not be used for patients who take cardiac glycosides. Simultaneous reception of Digoxin in combination with reserpine, propranolol, phenytoin increases the likelihood of ventricular arrhythmia.
Reduces the concentration and effectiveness of the drug phenylbutazone and preparations of the barbiturate group. Also reduce the therapeutic effect of potassium preparations, drugs that reduce the acidity of gastric juice, metoclopramide. When combined with antibiotics erythromycin and gentamicin, the glycoside content in the patient's plasma increases. Simultaneous reception of the drug with cholestipol, cholestyramine and magnesium laxatives leads to a deterioration in the absorption of the drug in the intestine, as a result of which there is a decrease in the amount of digoxin in the body. Metabolism of glycosides is accelerated when combined with rifampicin and sulfosalazine.

Storage conditions

In a place inaccessible to children at a temperature of 15-30 degrees Celsius.
Shelf life not more than three years.

special instructions

In pediatric practice, the tablet form is not used.

In pregnancy and lactation

The effect of the drug on the fetus in clinical studies has not been studied, but the drug is able to overcome the hematoplacental barrier and enter the fetus. Digoxin in pregnancy is prescribed only for emergency indications.
If a nursing mother is taking this medication, the child should constantly monitor the heart rate.

Reviews about digoxin

Comments on the benefits of the drug is not enough. Undoubtedly, the medicine is very powerful, and it should be used only under the supervision of a doctor. There is also a large number of negative reviews about Digoxin, which report that the drug does not help with use, but only shows numerous side effects.