L B M M C / P H A R M A C Y S E R V I C E S

M E D I C A T I O N A D M I N I S T R A T I O N

M A N U A L

Non-Critical Care Areas

All Critical Care Areas

DIGOXIN (LANOXIN)
ROUTES OF ADMINISTRATION
IM, IV push, IV intermittent infusion

METHODS FOR IV ADMINISTRATION AND DOSAGE

1. Initial digitalizing doses should be administered by IV push over at least 5 minutes. Daily

maintenance doses may be administered by intermittent infusion over > 5 minutes. Maximum
dose is 1 mg/24 hours.
2. Dose may be administered either undiluted or diluted (at least 4 fold) with sterile water for
injection, NS, or D5W
3. For IM administration, the injection should be made deep into the muscle and should be followed
by massage of the injection site. No more than 2 mL of digoxin injection should be given at one
site. IM digoxin administration is generally discouraged due to severe local irritation and
unpredictable effects.
4. Dosage:
Non-Critical Care Areas: The maximum single dose is 0.5 mg when administered in a noncritical care area. The maximum total dose in non-critical care areas on the first day is 0.75
mg. For doses in excess of these, the patient must be transferred to a critical care area or
telemetry unit.
Critical Care, DOU and Telemetry Areas: Digoxin has a narrow toxic to therapeutic
ratio. Cautious dosage determination is essential. The estimated total digitalizing dosage
(typically 1 mg) should be given in divided doses at intervals sufficient to allow the full effect
of each dose to occur before subsequent doses are administered (4 - 6 hours is
recommended).

INDICATIONS FOR IV USE

1. Rapid digitalization in emergency situations.

2. To control ventricular rate in patients with atrial fibrillation.
3. To control tachyarrhythmias in cardiac patients treated with a general anesthetic during surgery.

MONITORING PARAMETERS

1. Heart rate
2. Electrolytes
3. Renal function (BUN and serum creatinine should be assessed periodically)

POTENTIAL PROBLEMS WITH IV ADMINISTRATION

1. Cardiac arrhythmias of all kinds have been reported with digitalis intoxication and may be the

first presenting symptoms, especially with hypokalemia.

2. Although digoxin injection has been given IM, this route of administration is rarely justified
because it frequently causes severe local irritation and produces less reliable and consistent blood
levels than do the IV or oral routes.
3. Gastrointestinal upset or neurological problems (drowsiness, dizziness, and confusion)
may occur. Anorexia, nausea and vomiting are common early signs of drug toxicity.

DIGOXIN (LANOXIN)

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L B M M C / P H A R M A C Y S E R V I C E S
M E D I C A T I O N A D M I N I S T R A T I O N

M A N U A L

TREATMENT OF ADVERSE SIDE EFFECTS

1. Cardiac arrhythmias: Discontinue the drug and correct hypokalemia, if present.

Hypomagnesemia and/or hypocalcemia should also be corrected. Lidocaine 1 - 1.5 mg/kg IV

initially followed by 0.5 - 1.5 mg/kg IV every 5 - 10 minutes up to a maximum of 3 mg/kg;
and/or phenytoin 50 100 mg every 10 - 15 minutes to a maximum of 15 mg/kg may be given, if
necessary.
2. Although propranolol 0.5 - 1 mg IV every 5 - 10 minutes is effective in the treatment of digoxin
induced ventricular and supraventricular arrhythmias, it should used with caution because it may
compromise conduction through the AV node and may also cause bradycardia.
3. For severe sinus bradycardia or cardiac arrest, atropine or the use of a transcutaneous/transvenous
pacemaker may be necessary.
4. Digoxin Immune FAB (Digibind, DigiFab) may be indicated to reverse severe sinus
bradyarrhythmias and/or advanced AV block in cases of severe digoxin intoxication.

REFERENCES
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8.

Manufacturer product information.

Adult Advanced Cardiac Life Support. JAMA. 1992;268 (October 28):2199-2241.
Martindale, W. The Extra Pharmacopoeia, 1972
Side Effect of Drugs, 1972
Lowin G et al. The sensitivity to digitalis drugs in acute myocardial infarction. Am J Cardiology. 1972;30:388
Doherty J et al. Studies with titrated digoxin in human subjects after intravenous administration. Am Heart J. 1962;63:528-536
AHFS Drug Information. McEvoy GK,ed, Bethesda, MD: American Society of Healthy-System Pharmacists, 2005.
Phelps SJ, Teddy Bear Book: Pediatric Injectable Drugs, 6th ed., Bethesda, MD: American Society of Health-System Pharmacists, 2002.

DIGOXIN (LANOXIN)

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