Digoxin

Drug classes:
● Cardiac glycoside
● Cardiotonic agent

Therapeutic actions: Increases intracellular calcium and allows more calcium to enter the
myocardial cell during depolarization via a sodium–potassium pump mechanism; this increases
force of contraction (positive inotropic effect), increases renal perfusion (seen as diuretic effect
in patients with heart failure), decreases heart rate (negative chronotropic effect), and decreases
AV node conduction velocity.

Indications:
● Mild to moderate congestive heart failure and for treating an abnormal heart rhythm called
atrial fibrillation, arterial flutter, Paroxysimal atrial tachycardia

Contraindications and cautions:

● Contraindicated with allergy to cardiac glycosides, ventricular tachycardia, ventricular
fibrillation, heart block, sick sinus syndrome, IHSS, acute MI, renal insufficiency and electrolyte
abnormalities (decreased K+, decreased Mg2+, increased Ca2+).
● Use cautiously with pregnancy and lactation

Dosage:
Loading dose, 0.25 mg/day IV or PO for patients younger than 70 yr with good renal
function; 0.125 mg/day for patients older than 70 yr or with impaired renal function; or
0.0625 mg/day for patients with marked renal impairment. Maintenance dose, 0.125–0.5 mg/day
PO.

Adverse effects:
● CNS: Headache, weakness, drowsiness, visual disturbances, mental status change
● CV: Arrhythmias
● GI: GI upset, anorexia

Nursing Management:
● Monitor apical pulse for 1 min before administering; hold dose if pulse lower
than 60 beats/min in adult or lower than 90 beats/min in infant; retake pulse in 1 hr. If adult
pulse remains lower than 60 beats/min or infant pulse remains lower than 90 beats/min, hold
drug and notify prescriber. Note any change from baseline rhythm or rate.
● Check dosage and preparation carefully.
● Avoid IM injections, which may be very painful.
● Follow diluting instructions carefully, and use diluted solution promptly.
● Avoid giving with meals; taking this drug with food will delay absorption and alter drug
pharmacokinetics.