Arch Pharm Res. This content does not have an English version. Zhao L, Yang P, Li P, Wang X, Qin W, Zhang X. Clin Interv Aging. It is used when adjusting the initial dose, and to ensure that digoxin levels stay within an acceptable range. Obtain blood samples at least 4 hrs after IV dose and 6-8hrs after oral dose. information is beneficial, we may combine your email and website usage information with Your doctor may adjust your dose as needed. Please enable it to take advantage of the complete set of features! -, Dis Chest. What to Use: Chemical or Natural Sunscreens? 1978 Jan;41(1):88-93 In urgent cases: Dilute 500mcg (2ml) of digoxin with at least 8ml of sodium chloride 0.9% or glucose 5% (total volume = 10ml) and give by slow intravenous injection over 10-20 minutes The age, serum potassium levels and renal function of the patient should also be taken into account when dosing digoxin. Declining renal function can lead to digoxin accumulation Digoxin levels 4 weeks post initiation and yearly, and in the event of signs or symptoms of toxicity Digoxin trough level preferred - blood draw prior to next scheduled dose or 8 - 12 hours after a dose Be aware of drug interactions e.g. Treatment of mild to moderate heart failure in adults. 58 Therefore, these drugs require close monitoring when initiating, adjusting, or discontinuing digoxin drug therapy. - Digoxin levels should be interpreted and acted on based on clinical signs and symptoms. 26 For patients with an eGFR of 10-30 mL/min, a daily maintenance dose of 62.5-125 g is recommended and for patients with a GFR <10 mL/min, a maintenance dose of 62.5 g once daily or on alternate days is recommended. 10 Commandments of Polypharmacy Webinar based on my experiences in clinical practice, Benzodiazepine Comparison Table IV and Oral, Cardiovascular Medication and Disease State Clinical Pearls, Career Advice for Pharmacy Students, Residents and New Pharmacists, Clinical Guideline Updates For Pharmacists, Clinical Pharmacy News and New Drug Updates, Dermatology, ENT, Ophthalmology Case Studies, Dermatology, ENT, Ophthalmology Medication and Disease State Clinical Pearls, Drug Interaction Case Studies and Education For Pharmacists, Endocrine Medication and Disease State Clinical Pearls, Free Clinical Practice Quizzes and Videos For Pharmacists, Gastrointestinal Medication and Disease State Clinical Pearls, Hematology and Immunology Medication and Disease State Clinical Pearls, Infectious Disease and Oncology Case Studies, Infectious Disease and Oncology Medication and Disease State Clinical Pearls, Long Term Care Consultant Pharmacist Education and Information, Medication and Disease State Clinical Pearls For Pharmacists, Neurology, Pain, and Musculoskeletal Case Studies, Neurology, Pain, and Musculoskeletal Medication and Disease State Clinical Pearls, Pediatrics Medication and Disease State Clinical Pearls, Personal Stories From The Front Lines of Clinical Pharmacy, Pharmacist Board Certification Information And Help, Pharmacogenomics and Pharmacokinetics Case Studies, Pharmacogenomics and Pharmacokinetics Medication and Disease State Clinical Pearls, Polypharmacy Cases And The Prescribing Cascade, Psychiatry and Addiction Medication and Disease State Clinical Pearls, Psychiatry and Addiction Medicine Case Studies, Renal, Urology, and Electrolytes Case Studies, Renal, Urology, and Electrolytes Medication and Disease State Clinical Pearls, Respiratory Medication and Disease State Clinical Pearls, Womens and Mens Health Medication and Disease State Clinical Pearls, Writing Medication Recommendations For Pharmacists. Clin Pharmacokinet 1988; 15:165-179. Li X, Ao X, Liu Q, Yang J, Peng W, Tang R, Zhong Y, Meng T, Gan L, Zhou Q. Exp Ther Med. Clin Pharmacol Ther 1984; 36:70-73. If so, Id be more inclined to ask for an increase as the patient likely isnt benefitting from the current dosing. Bioavailability of digoxin tablets in healthy volunteers. Target trough level: 10 - 15 mg/L (15-20 mg/mL for severe infections) Dosing frequency. You'll usually take it once a day. To be given over at least 2 hours. Disclaimer, National Library of Medicine Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Measured serum level: Follow us Certification. diltiazem, verapamil, Time to steady state: 5-7 days (average) ESRD: 15-20 days. Toxicity During Chronic Therapy. If you have any questions about this or if you miss doses for 2 or more days in a row, check with your doctor. Find out about COVID-19, COVID-19 vaccines, and Mayo Clinic patient and visitor updates. Over 6,000 healthcare professionals follow the blog, why aren'tyou? . You've viewed {{metering-count}} of {{metering-total}} articles this month. In atrial fibrillation management, we may target a slightly higher level. But, if it is nearly time for your next dose, just take the next dose at the right time. and transmitted securely. This nomogram, shown below, is specifically intended for a more appropriate digoxin concentration of 0.7 ng/mL and has been shown to be more accurate than the traditional Jellife or Koup and Jusko methods. J Clin Pharmacol, 1974; 14:525-535. Steady state occurs within 7 to 10 days (1). Dosage for acute digoxin ingestion of a known amount Each vial of 40 mg binds approximately 0.5 mg of digoxin Oral tablets have a bioavailability of approximately 80%, therefore the digoxin load is multiplied by 0.8 Dose (# vials) = (total ORAL digoxin body load in mg) (0.8 ) 0.5 IV digoxin is 100% bioavailable; therefore, the formula is as . Total digoxin load (mg) divided by 0.5 mg digoxin bound per vial = number of vials to use. Do not take more of it than your doctor ordered and do not miss any doses. C) The client should be taught to increase sodium in the diet. The mathematical backbone of this program is based on the references below. hydroxychloroquine sulfate. Adjust dose based on toxicity, efficacy, and blood levels. Scenario 3: After Dose Adjustment In normal healthy subjects after dose adjustment, the phenytoin level should be drawn within six to Detailed Digoxin dosage information for adults and children. Behr ER, Veysey MJ, Berry D, Volans GN. For intravenous infusion ( Lanoxin ), give intermittently in Glucose 5% or Sodium chloride 0.9%; dilute to a concentration of not more than 62.5 micrograms/mL. 2014 Jul 22;9:1205-10. doi: 10.2147/CIA.S63596. SummaryDue to the narrow therapeutic-to-toxic ratio of digoxin, numerous studies have been done to assess the optimal digoxin level in patients with congestive heart faiiure. Adjust maintenance dose, F = Bioavailability factor Twenty-two patients were given amiodarone for refractory cardiac arrhythmias, and pre- and post-amiodarone serum digoxin levels were studied. Therapeutic levels of digoxin are 0.8-2.0 ng/mL. Therapeutic drug monitoring/range: 0.5 to 2 ng/mL; some patients with atrial fibrillation may require 2 to 4 ng/mL. The site is secure. 1982 Sep;24(3):229-39 Clin Pharmacokinet. other information we have about you. 2. C = correction factor for interacting drugs: Cp = target serum level (mcg/l) Periodically monitor the drug level to make . Total loading dose: Administer one-half the total loading dose initially (all formulations), then give one-fourth the total loading dose every 6 to 8 hours for two doses (IV and tablets), or give additional fractions every 4 to 8 hours (oral solution). dosing is therefore of little importance for correctly interpreting the plasma concentration4. Enjoy the blog? Includes dosages for Congestive Heart Failure and Atrial Fibrillation; plus renal, liver and dialysis adjustments. Obtain first level within 24 hours of digitalization. Id more urgently recommend a recheck if the out of range digoxin level was on the upper end. It is inherently difficult because of such components as narrow therapeutic index, difficult to define therapeutic endpoints, inter and intra-patient variability, and varying effects of pathological states and drugs on digoxins disposition. Enjoy the blog? Adjustment of digoxin and/or rhPTH dose may be needed. The nurse would anticipate the client's digitalis level to be: 2.7 nanograms/mL. 1995 May;28(5):405-18. doi: 10.2165/00003088-199528050-00005. A rough guide to making an adjustment to the daily dose that should increase a serum level without leading to supratherapeutic / toxic levels is: If the phenytoin concentration is < 7 mcg/mL, the dose may be increased by 100 mg/day. You can take digoxin with or without food, but it's best to take it at the same time each day. Oral solution: 0.05 mg (50 mcg) per 1 milliliter (mL) dose 18. However, the maintenance dose is usually 4.7 to 7.8 mcg per kg of body weight per day. The program then requires the date and time the current dosage regimen was initiated, this is used to determine whether the patients digoxin level is at a steady-state. Cp = Steady-state serum digoxin concentration (mcg/l) Note that toxicity may occur with a level of less than 1.3nmol/l if there is hypokalaemia. Digoxin is primarily cleared by the kidney and can rise as renal function declines. monitoring digoxin levels. Konishi H, Shimizu S, Chiba M, Minouchi T, Koida M, Yamaji A. J Clin Pharm Ther. official website and that any information you provide is encrypted 5. Lancet. Reduce dose in patients whose lean weight is an abnormally small fraction of total body mass (e.g., obesity, edema). Your doctor may adjust your dose as needed. Digoxin dosing should be based on ideal body weight. Indications and Dosage. However, the maintenance dose is usually 5.6 to 11.3 mcg per kg of body weight per day. Predicted Css= (Dose) (0.65 to 0.8)/ Digoxin clearance. Unable to load your collection due to an error, Unable to load your delegates due to an error. Digoxin half-life is 20-50 hours; prolonged with renal impairment. Liver Dose Adjustments. For heart failure or atrial fibrillation: Adults, teenagers, and children 10 years of age and olderDose is based on age, body weight, and medical condition and must be determined by your doctor. To convert from g/L to nmol/L multiply by 1.28. Serum digoxin levels less than 0.5 ng/mL have been associated with diminished efficacy, while levels above 2 ng/mL have been associated with increased toxicity without increased benefit. Digoxin level determinations were always considered to have an appropriate indication when a subtherapeutic response or previously undocumented toxic effects were suspected, when evaluating a high-risk patient, after initiation of digoxin therapy or dosage adjustment after steady state was reached, and as an admission level in inpatients and . No adjustment recommended. 47.9% of digoxin levels were in subtherapeutic range, 45.4% of were in therapeutic range, and 6.7% of were in toxic range.