Monograph Details
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Cardiovascular System
> CHF and arrhythmias
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LANOXIN |
| Manufacturer |
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GlaxoSmithKline Pharmaceuticals |
| Legal Classification |
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Rx
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| Pharmacological Class |
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Cardiac glycoside. |
| Generic Name |
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Digoxin 0.125mg, 0.25mg; scored tabs. |
| Also |
• LANOXICAPS
• LANOXIN INJECTION
• LANOXIN INJECTION PEDIATRIC
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| Indications |
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Mild-to-moderate heart failure (with a diuretic and an ACE inhibitor when possible). Control of ventricular response rate in chronic atrial fibrillation. |
| Adults and Children |
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Individualize: see literature. Reduce dose in premature and immature infants. Children usually need proportionally larger doses (based on body weight or surface area) than adults. Use divided doses for children <10 yrs. Retitrate when changing formulations (esp. oral tabs to or from other dose forms). Lanoxicaps: if dose is ≥0.3mg/day, or if history of or predisposition to digoxin toxicity, or if compliance is not a problem, use divided doses. |
| Contraindications |
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Ventricular fibrillation. |
| Precautions |
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Renal dysfunction: reduce dose. Sinus node disease. Incomplete AV block. Accessory AV pathway (Wolff-Parkinson-White syndrome). Heart failure with preserved LV ejection fraction (eg, restrictive cardiomyopathy, constrictive pericarditis, amyloid heart disease, acute cor pulmonale, idiopathic hypertrophic subaortic stenosis). Electrical cardioversion. Acute MI. Toxicity risk increased by hypokalemia, hypomagnesemia, hypercalcemia. Hypocalcemia may nullify effects. Thyroid disease. Hypermetabolic states. Monitor digoxin levels, electrolytes, renal function. Premature infants. Neonates. Pregnancy (Cat.C). Nursing mothers. |
| Interactions |
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Toxicity risk increased by potassium-depleting drugs (eg, diuretics, amphotericin B, corticosteroids). Digoxin levels increased by antibiotics (eg, macrolides, tetracyclines), amiodarone, propafenone, quinidine, verapamil, indomethacin, itraconazole, alprazolam, spironolactone, drugs that reduce GI motility (eg, propantheline, diphenoxylate), thyroid antagonists, drugs that reduce renal function. Digoxin levels decreased by thyroid hormones, antacids, kaolin-pectin, cholestyramine, rifampin, sulfasalazine, neomycin, drugs that increase GI motility (eg, metoclopramide), some antineoplastics. Digoxin levels possibly affected by quinine, penicillamine, felodipine, others. Arrhythmias with sympathomimetics, succinylcholine, or rapid calcium infusion. Heart block with drugs that affect cardiac conduction (eg, calcium channel blockers, β-blockers). |
| Adverse Reactions |
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GI upset, anorexia, CNS effects (eg, blurred or yellow vision, or mental disturbances, confusion, headache, weakness, dizziness, apathy), gynecomastia, rash, heart block, arrhythmias (esp. children). |
| How Supplied |
Tabs—100, 1000
Inj 0.25mg/mL (2mL amps)—10, 50
Inj Pediatric (1mL amp)—10
Lanoxicaps—100 |
| Additional Resources |
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• Related Prescribing Note |
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