IntravenousCardiac arrhythmias, Heart failureAdult: 100-600 mcg daily, depending upon desired digitalisation (usually performed over 2-4 days); larger doses are given in divided doses. Maintenance: Continue with 50-300 mcg daily by mouth in divided doses.
Elderly: Dose reduction may be required.
OralCardiac arrhythmias, Heart failureAdult: 100-600 mcg daily, depending upon desired digitalisation (usually performed over 2-4 days); larger doses are given in divided doses.
Elderly: Dose reduction may be required.
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CrCl <50 mL/min per 1.48 m2: Dose reduction may be needed. Dialysis: Initially, 30-50% of the usual dose.
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Wolff-Parkinson-White syndrome or other evidence of an accessory pathway; hypertrophic obstructive cardiomyopathy.
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Severe pulmonary disease, hypoxia, myxoedema, acute MI, severe heart failure, acute myocarditis, chronic constrictive pericarditis, acute glomerulonephritis and CHF, idiopathic hypertrophic subaortic stenosis. IV admin in hypertensive patients. Incomplete AV block, especially in those with Adams-Stokes attacks. Increased carotid sinus sensitivity, frequent ventricular premature contractions or ventricular tachycardia. Withhold 1-2 days before elective cardioversion. Electrolyte disturbances, thyroid dysfunction. Elderly, premature infants, renal impairment. Not an appropriate form of therapy for any ventricular arrhythmia. Pregnancy.
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Nausea, vomiting, anorexia, diarrhoea, abdominal pain, headache, facial pain, fatigue, weakness, dizziness, drowsiness, disorientation, mental confusion, bad dreams, delirium, acute psychoses, hallucinations, convulsions, blurred vision, colour vision may be affected, gynaecomastia.
Potentially Fatal: Heart failure, supraventricular or ventricular arrhythmias, conduction defects.
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Symptoms: Nausea, vomiting, anorexia, diarrhoea, abdominal pain, headache, facial pain, fatigue, weakness, dizziness, drowsiness, disorientation, mental confusion, bad dreams, delirium, acute psychoses, hallucinations, convulsions, blurred vision, colour vision may be affected, gynaecomastia. Management: Acute poisoning: Gastric lavage if patient presents within 1 hr of ingestion. Repeated doses of activated charcoal, colestyramine and colestipol may be given. Haemodialysis or peritoneal dialysis, and forced diuresis with furosemide have generally been ineffective. Antiarrhythmic treatment may be necessary. Correct hypokalaemia and other electrolyte disturbances. Massive poisoning: Reverse progressive hyperkalaemia. Soluble insulin with glucose may be given; if refractory, dialysis may be tried. Massive overdosage has been treated successfully with digoxin-specific antibody fragments.
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Increased risk of additive bradycardia with diltiazem. Increased risk of digitalis toxicity with amphotericin B, carbenoxolone, corticosteroids. Increased CV adverse events with HRT. Reduced serum digoxin levels with rifampicin, colestyramine.
Potentially Fatal: Increased digitalis glycosides toxicity with potassium-depleting diuretics. Increased risk of cardiac arrhythmias with IV calcium.
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Many herbal preparations contain cardiac glycosides; additive effects with metildigoxin may possibly occur.
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Description:
Mechanism of Action: Metildigoxin is a cardiac glycoside with positive inotropic activity.
Onset: 5-20 min.
Pharmacokinetics:
Absorption: Rapidly and almost completely absorbed from the GI tract.
Metabolism: Hepatic demehylation to digoxin; reduced in patients with cirrhosis.
Excretion: Via urine (about 60% of dose; as unchanged drug and metabolites).
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