NEODOSE

INDICATIONS

• Heart Failure or Arrhythmias: Treatment of heart failure caused by diminished myocardial contractility. Treatment of SVT, atrial flutter, and atrial fibrillation. In neonates with pulmonary hypertension, supportive care with digitalis may be used cautiously for signs of right-sided heart failure; however, the data are limited and digoxin is rarely used in the pediatric population. Digoxin is not effective for acute deterioration

CONTRAINDICATIONS

Contraindicated with ventricular fibrillation or a history of hypersensitivity to digoxin or other digitalis preparations.

PRECAUTIONS

Use caution in patients with low body weight, hypokalemia, hypomagnesemia, hypercalcemia, and renal impairment, as risk of digoxin toxicity is higher in these patients; monitoring and dose adjustment may be required. Wolff-Parkinson-White syndrome patients with atrial fibrillation have an increased risk of ventricular fibrillation. Severe sinus bradycardia or sinoatrial block may occur, especially in patients with preexisting sinus node disease or incomplete atrioventricular block; consider pacemaker placement before initiating treatment. Decreased cardiac output may develop with use in patients with heart failure associated with preserved left ventricular systolic function. May induce ventricular arrhythmias in patients undergoing electrical cardioversion; consider reducing dose or discontinuing use 1 to 2 days prior to procedure. Avoid use in patients with myocarditis; use not recommended in patients with acute myocardial infarction. Drugs that affect renal function (eg, ACE inhibitors, angiotensin receptor blockers, NSAIDs, COX-2 inhibitors) may increase digoxin exposure.

ADVERSE EFFECTS

• Toxic Cardiac Effects:
  • PR interval prolongation
  • Sinus bradycardia or SA block
  • Atrial or nodal ectopic beats
  • Ventricular arrhythmias
• Nontoxic Cardiac Effects:
  • QTc interval shortening
  • ST segment sagging
  • T-wave amplitude dampening
  • Heart rate slowing
• Other Effects:
  • Feeding intolerance, vomiting, diarrhea, and lethargy.

Treatment of Life-Threatening Digoxin Toxicity

Digibind® Digoxin Immune Fab, IV over 30 minutes through 0.22-micron filter. Dose(#of vials) = (weight[kg]) x(serum digoxin concentration)/100 Each vial of digibind contains 38 mg(enough to bind 0.5 mg Digoxin.

ADMINISTRATION

Intravenous:

Infuse concentrations of 20 mcg/mL or 100 mcg/mL over 15 to 30 minutes.

Oral:

Give consistently with regard to feedings.

MONITORING

Follow heart rate and rhythm closely. Periodic EKGs to assess both desired effects and signs of toxicity. Follow closely (especially in patients receiving diuretics or amphotericin B) for decreased serum potassium and magnesium, or increased calcium and magnesium, all of which predispose to digoxin toxicity. Assess renal function. Be aware of drug interactions. May follow serum drug concentrations if assay is available that excludes endogenous digoxinlike substances. Therapeutic serum concentration is 1 to 2 nanograms/mL.