Digoxin is a cardiac glycoside primarily used to treat heart failure and certain arrhythmias. It enhances myocardial contractility, reduces myocardial oxygen consumption, and improves cardiac pumping function. This medication is commonly used in chronic heart failure patients to alleviate symptoms such as dyspnea and edema, and it can also regulate heart rate in atrial fibrillation or sinus tachycardia.
Digoxin has a narrow therapeutic window, requiring regular monitoring of blood levels to prevent toxicity. Its mechanism of action involves inhibiting the sodium-potassium ATPase pump, leading to increased intracellular calcium ions, which in turn enhances cardiac contractility. Clinical use must consider renal function, as the drug is primarily excreted via the kidneys.
The generic name is Digoxin. Common brand names include:
Digoxin belongs to the Cardiac Glycosides class of drugs, characterized by both cardiovascular and electrophysiological effects. Its features include:
Main indications include:
This drug is especially effective in patients with normal left ventricular systolic function but significant cardiac dilation, but caution is needed in patients with severely impaired systolic function (LVEF <30%) to evaluate benefit-risk ratio.
Mild side effects include:
Serious side effects may include:
Contraindications include:
Pregnancy category C, use only if benefits outweigh risks. Avoid during breastfeeding, as the drug may be excreted into breast milk. Patients over 65 should pay special attention to renal function due to age-related decline in metabolism.
Concurrent use with the following drugs may increase toxicity risk:
When combined with amiodarone or beta-blockers, close ECG monitoring is required to avoid conduction block. Combining with calcium channel blockers may increase the risk of hypokalemia; electrolyte levels should be regularly checked.
Oral forms are usually taken once or multiple times daily. Initial doses are adjusted based on body weight and renal function, with common starting doses of 0.125-0.25 mg/day in adults. Intravenous injection is limited to emergency situations and should be administered slowly under medical supervision.
Consistent timing is important to maintain stable blood levels. Taking with food after meals can reduce gastrointestinal discomfort. Therapeutic effects may take 5-7 days; chronic heart failure treatment requires continuous use to maintain efficacy.
If a dose is missed within 6 hours of the scheduled time, take it immediately and adjust the next dose accordingly; if more than 6 hours have passed, skip the missed dose and resume normal schedule the next day. Do not double the dose.
If multiple doses are missed resulting in worsening symptoms (e.g., increased dyspnea), seek medical evaluation promptly to determine if treatment adjustment is necessary. Using reminder systems and fixed medication schedules can effectively reduce missed doses.
Signs of toxicity include visual disturbances, bradycardia or arrhythmias, nausea, and vomiting. Suspected overdose requires immediate medical attention, possibly using digoxin-specific antibody fragments (Digibind) for detoxification.
Emergency measures include:
Does the timing of digoxin administration need to be coordinated with meals?
It is recommended to take digoxin at a fixed time to maintain stable blood levels, but it can be taken before or after meals. If gastrointestinal discomfort occurs, taking it with food may help alleviate symptoms. The key is to take it consistently at the same time daily and avoid missed doses or double dosing.
What should I do if I experience nausea or vomiting while taking digoxin?
Mild nausea may be caused by gastrointestinal irritation; taking the medication in divided doses or with food can help. If symptoms persist or worsen, stop the medication and contact your doctor. Dose adjustment or toxicity assessment may be necessary.
Are there any drug interactions I should be aware of when taking digoxin with other medications (such as antibiotics or antihypertensives)?
Digoxin may interact with certain antibiotics (e.g., macrolides), antiarrhythmic drugs, or diuretics, affecting efficacy or increasing toxicity risk. Always inform healthcare providers about all medications you are taking and regularly monitor blood drug levels.
Do I need to restrict certain foods or activities while taking digoxin?
Avoid excessive intake of high-potassium foods (e.g., bananas, avocados, spinach), as high potassium levels can exacerbate side effects. Moderate exercise is recommended; if palpitations or chest tightness occur after activity, stop immediately and consult a physician.
What should I do if I miss a dose?
If a dose is missed and the next dose is within 6 hours, take it immediately and continue with the regular schedule; do not double doses. If the missed dose is more than 6 hours late, consult healthcare providers for appropriate steps to prevent blood level fluctuations that could affect treatment efficacy.
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