digoxin (Lanoxin, Lanoxicaps, Digitek)

From Aaushi
Jump to navigation Jump to search

Introduction

Tradenames: Lanoxin, Lanoxicaps, Digitek. RECALL: [04/28/2008] nationwide, all strengths of Digitek recalled due to the possibility that tablets may contain twice the approved level of digoxin[13]

Indications

* associated with higher mortality among patients with atrial fibrillation (RR= 1.2)[21][22][25]

Contraindications

pregnancy category = c

safety in lactation = ?

Dosage

* 0.125 mg PO QD is enough for most patients[10] 0.125 mg PO QOD is enough for most patients with therapeutic range of 0.5-0.9 ng/mL[12]

Lanoxin: 0.125, 0.25, 0.5 mg.

Elixir: 0.05 mg/mL.

Lanoxicaps: 0.05, 0.1, 0.2 mg.

No role for IV digoxin if patient can take oral meds[4]

Dosage adjustment in renal failure

Pharmacokinetics

* 0.5-1.0 ng/mL may be more appropriate range (see serum digoxin)

elimination via liver

elimination via kidney

1/2life = 1.4-1.8 days

protein binding = 23 %

elimination by hemodialysis = -

elimination by hemoperfusion = +

elimination by peritoneal dialysis = -

Monitor

Adverse effects

incidence: (toxicity)

  • 5-15% of patients at some time during therapy

precipitating factors:

manifestations:

laboratory findings:

treatment:

Drug interactions

Laboratory

(see serum digoxin)

Mechanism of action

Comparative biology

Notes

More general terms

Additional terms

References

  1. Advanced Cardiac Life Support, The American Heart Association 1994
  2. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 132.
  3. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 120-21, 163-64
  4. 4.0 4.1 4.2 Paul Goebel UCSF Fresno Dept of Medicine, personal communication
  5. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  6. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  7. Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995
  8. 8.0 8.1 Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 470
  9. 9.0 9.1 9.2 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
    Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
    Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
  10. 10.0 10.1 Prescriber's Letter 9(12):68 2002 Journal Watch 22(24):181, 2002 Rathore SS et al, N Engl J Med 347:1402, 2002
  11. Prescriber's Letter 10(4):22 2003
  12. 12.0 12.1 Bauman JL, DiDomenico RJ, Viana M, Fitch M. A method of determining the dose of digoxin for heart failure in the modern era. Arch Intern Med. 2006 Dec 11-25;166(22):2539-45. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17159022
  13. 13.0 13.1 FDA MedWatch http://www.fda.gov/medwatch/safety/2008/safety08.htm#Digitek
  14. 14.0 14.1 14.2 14.3 Prescriber's Letter 17(7): 2010 Recommended Lab Monitoring for Common Medications Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260704&pb=PRL (subscription needed) http://www.prescribersletter.com
  15. 15.0 15.1 Chan KE et al Digoxin Associates with Mortality in ESRD J Am Soc Nephrol. 2010 Jun 24. [Epub ahead of print] <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20576808 <Internet> http://jasn.asnjournals.org/cgi/content/abstract/ASN.2009101047v1
  16. 16.0 16.1 Huh JR et al Digoxin and its derivatives suppress TH17 cell differentiation by antagonizing RORt activity. Nature 2011 Apr 28; 472:486 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21441909
    Solt LA et al. Suppression of TH17 differentiation and autoimmunity by a synthetic ROR ligand. Nature 2011 Apr 28; 472:491 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21499262
    Jetten AM. A helping hand against autoimmunity. Nature 2011 Apr 28; 472:421 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21525918
  17. Vivo RP, Krim SR, Perez J et al Digoxin: current use and approach to toxicity. Am J Med Sci. 2008 Nov;336(5):423-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19011400
  18. 18.0 18.1 Medical Knowledge Self Assessment Program (MKSAP) 16, 18 American College of Physicians, Philadelphia 2012, 2018
  19. Heckman GA, McKelvie RS. Necessary cautions when considering digoxin in heart failure. CMAJ. 2007 Feb 27;176(5):644-5. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17325330
  20. Pita-Fernandez S, Lombardia-Cortina M, Orozco-Veltran D et al Clinical manifestations of elderly patients with digitalis intoxication in the emergency department. Arch Gerontol Geriatr. 2011 Sep-Oct;53(2):e106-10 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20705347
  21. 21.0 21.1 Husten L Study Offers Little Support for Digoxin in Atrial Fibrillation. Physician's First Watch, Aug 12, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org article appeas in Journal of the American College of Cardiology (JACC) in August 2014
  22. 22.0 22.1 Washam JB et al. Digoxin use in patients with atrial fibrillation and adverse cardiovascular outcomes: A retrospective analysis of the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). Lancet 2015 Mar 5; PMID: https://www.ncbi.nlm.nih.gov/pubmed/25749644
  23. Ziff OJ et al Safety and efficacy of digoxin: systematic review and meta- analysis of observational and controlled trial data. BMJ 2015;351:h4451 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26321114 <Internet> http://www.bmj.com/content/351/bmj.h4451
  24. 24.0 24.1 24.2 See I, Shehab N, Kegler SR, Laskar SR, Budnitz DS. Emergency department visits and hospitalizations for digoxin toxicity: United States, 2005 to 2010. Circ Heart Fail. 2014 Jan;7(1):28-34. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24300242 Free PMC Article
  25. 25.0 25.1 Lopes RD, Rordorf R, De Ferrari GM et al Digoxin and Mortality in Patients With Atrial Fibrillation. J Am Coll Cardiol. 71(10) March 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29519345 <Internet> http://www.onlinejacc.org/content/71/10/1063
    Turakhia MP Digoxin in Atrial Fibrillation? Leave it Out of the Medicine Cabinet. J Am Coll Cardiol. 71(10) March 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29519346 <Internet> http://www.onlinejacc.org/content/71/10/1075
  26. 26.0 26.1 Mattison MLP, Muse VV, Simmons LH Case 15-2018: An 83-Year-Old Woman with Nausea, Vomiting, and Confusion. N Engl J Med 2018; 378:1931-1938. May 17, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29768145 https://www.nejm.org/doi/full/10.1056/NEJMcpc1800339
    Rothaus C A Woman with Nausea, Vomiting, and Confusion. NEJM. Resident 360. May 16, 2018 https://resident360.nejm.org/content_items/a-woman-with-nausea-vomiting-and-confusion
  27. 27.0 27.1 Adams KF Jr, Butler J, Patterson JH et al Dose response characterization of the association of serum digoxin concentration with mortality outcomes in the Digitalis Investigation Group trial. Eur J Heart Fail. 2016 Aug;18(8):1072-81. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27492641 Free Article
  28. 28.0 28.1 Ambrosy AP, Butler J, Ahmed A et al The use of digoxin in patients with worsening chronic heart failure: reconsidering an old drug to reduce hospital admissions. J Am Coll Cardiol. 2014 May 13;63(18):1823-32. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24613328 Free Article
  29. 29.0 29.1 Dooley DJ, Lam PH, Ahmed A, Aronow WS. The Role of Positive Inotropic Drugs in the Treatment of Older Adults with Heart Failure and Reduced Ejection Fraction. Heart Fail Clin. 2017 Jul;13(3):527-534. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28602370

Database