Know the basics
What is digoxin used for?
Digoxin is used to treat heart failure, usually along with other medications. It is also used to treat a certain type of irregular heartbeat (chronic atrial fibrillation). Treating heart failure may help maintain your ability to walk and exercise and may improve the strength of your heart. Treating an irregular heartbeat can decrease the risk for blood clots, an effect that may reduce your risk for a heart attack or stroke.
Digoxin belongs to a class of medications called cardiac glycosides. It works by affecting certain minerals (sodium and potassium) inside heart cells. This reduces strain on the heart and helps it maintain a normal, steady, and strong heartbeat.
How should I take digoxin?
Take digoxin by mouth with or without food, usually once daily or as directed by your doctor. If you are using the liquid form of this medication, carefully measure the dose using the dropper provided by the manufacturer. Do not use a household spoon because you may not get the correct dose.
Your body may not absorb this drug as well if you also eat foods that are high in fiber or if you take certain medications. Therefore, take digoxin at least 2 hours before or after eating food products that are high in fiber (such as bran). If you are also taking cholestyramine, colestipol, or psyllium, wait at least 2 hours after taking your digoxin dose before taking any of these products. If you are taking antacids, kaolin-pectin, milk of magnesia, metoclopramide, sulfasalazine, or aminosalicylic acid, take them as far apart from your digoxin dose as possible. Ask your pharmacist if you are not sure when to take any of your medications.
The dosage of digoxin is based on your medical condition, age, body weight, laboratory tests, and response to treatment.
Use digoxin regularly to get the most benefit from it. To help you remember, use it at the same time each day. Do not stop taking digoxin without consulting your doctor. Some conditions may become worse when digoxin is suddenly stopped.
Tell your doctor if your condition does not improve or if it worsens.
How do I store digoxin?
Digoxin is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store digoxin in the bathroom or the freezer. There may be different brands of digoxin that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.
You should not flush digoxin down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.
Know the precautions & warnings
What should I know before using digoxin?
Before taking digoxin,
- tell your doctor and pharmacist if you are allergic to digoxin, digitoxin, or any other drugs.
- tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially antacids, antibiotics, calcium, corticosteroids, diuretics (‘water pills’), other medications for heart disease, thyroid medications, and vitamins.
- tell your doctor if you have or have ever had thyroid problems, heart arrhythmias, cancer, or kidney disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking digoxin, call your doctor.
- talk to your doctor about the risks and benefits of taking this medication if you are 65 years of age or older. Older adults should usually receive low doses of digoxin because higher doses may cause serious side effects.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking digoxin.
- you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
- remember that alcohol can add to the drowsiness caused by this medication.
Is it safe to take digoxin during pregnancy or breast-feeding?
There are no adequate studies in women for determining risk when using this medication during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking this medication. This medication is pregnancy risk category C according to the US Food and Drug Administration (FDA).
FDA pregnancy risk category reference below:
- A=No risk,
- B=No risk in some studies,
- C=There may be some risk,
- D=Positive evidence of risk,
Know the side effects
What are the side effects of digoxin?
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have a serious side effect such as:
- Fast, slow, or uneven heart rate;
- Bloody or black, tarry stools;
- Blurred vision, yellowed vision;
- Confusion, hallucinations, unusual thoughts or behavior.
Less serious side effects may include:
- Nausea, vomiting, diarrhea, loss of appetite;
- Feeling weak or dizzy;
- Headache, anxiety, depression;
- Enlarged breasts in men;
- Mild skin rash.
Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.
Know the interactions
What drugs may interact with digoxin?
Digoxin may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alprazolam, Amiodarone, Bemetizide, Bendroflumethiazide, Benzthiazide, Boceprevir, Buthiazide, Calcium, Canagliflozin, Chan Su, Chlorothiazide, Chlorthalidone, Clarithromycin, Clopamide, Cobicistat, Conivaptan, Crizotinib, Cyclopenthiazide ,Cyclothiazide, Daclatasvir, Demeclocycline, Diphenoxylate, Dofetilide, Dopamine, Doxycycline, Dronedarone, Eliglustat, Epinephrine, Erythromycin, Ezogabine, Fingolimod, Hydrochlorothiazide, Hydroflumethiazide, Indapamide, Indomethacin, Itraconazole, Kyushin ,Lapatinib, Ledipasvir, Lily of the Valley, Lomitapide, Methyclothiazide, Metolazone, Mifepristone, Minocycline, Moricizine, Nilotinib, Norepinephrine, Oleander, Oxytetracycline, Pheasant’s Eye, Polythiazide, Propafenone, Propantheline, Quercetin, Quinethazone, Quinidine, Ritonavir, Saquinavir, Simeprevir, Spironolactone, Squill, St John’s Wort, Succinylcholine, Telaprevir,Tetracycline, Tocophersolan, Trichlormethiazide, Ulipristal, Vandetanib, Verapamil, Xipamide.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acarbose, Acebutolol, Alprenolol, Aluminum Carbonate, Basic, Aluminum Hydroxide, Aluminum Phosphate, Aminosalicylic Acid, Arbutamine, Atenolol, Atorvastatin, Azithromycin, Azosemide, Bepridil, Betaxolol, Bevantolol, Bisoprolol, Bucindolol, Canrenoate, Captopril, Carteolol, Carvedilol, Cascara Sagrada, Celiprolol, Cholestyramine, Colchicine, Colestipol, Cyclosporine, Darunavir, Dihydroxyaluminum Aminoacetate, Dihydroxyaluminum Sodium Carbonate, Dilevalol, Diltiazem, Disopyramide, Epoprostenol, Esmolol, Etravirine, Exenatide, Flecainide, Fluoxetine, Furosemide, Gatifloxacin, Hydroxychloroquine, Indecainide, Labetalol, Lenalidomide, Lornoxicam, Magaldrate, Magnesium Carbonate, Magnesium Hydroxide, Magnesium Oxide, Magnesium Trisilicate, Mepindolol, Metipranolol, Metoclopramide, Metoprolol, Mibefradil, Miglitol, Mirabegron, Nadolol, Nebivolol, Nefazodone, Neomycin, Nilvadipine, Nisoldipine, Nitrendipine, Omeprazole, Oxprenolol, Pancuronium, Paromomycin, Penbutolol, Pindolol, Piretanide, Posaconazole, Propranolol, Quinine, Rabeprazole, Ranolazine, Rifampin, Rifapentine, Roxithromycin, Simvastatin, Sotalol, Sucralfate, Sulfasalazine, Talinolol, Telithromycin, Telmisartan, Tertatolol, Ticagrelor, Timolol, Torsemide, Tramadol, Trazodone, Trimethoprim, Valspodar.
Does food or alcohol interact with digoxin?
Digoxin may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.
What health conditions may interact with digoxin?
Digoxin may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.
- The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Blood vessel disease (e.g., arteriovenous shunt);
- Hypocalcemia (low calcium in the blood);
- Hypoxia (low oxygen in the blood);
- Thyroid disease—Use with caution. Patients with these conditions may be less sensitive or resistant to the effects of digoxin.
- Electrical cardioversion (a medical procedure)—Dose of digoxin may be reduced 1 to 2 days prior to electrical cardioversion of atrial fibrillation to avoid worsening of the condition.
- Heart disease (e.g., amyloid heart disease, AV block, constrictive pericarditis, cor pulmonale, heart attack, hypertrophic cardiomyopathy, restrictive cardiomyopathy, sick sinus syndrome, Wolff-Parkinson-White syndrome))—Avoid or use with caution. May make these conditions worse.
- Hypercalcemia (high calcium in the blood);
- Hypokalemia (low potassium in the blood);
- Hypomagnesemia (low magnesium in the blood)—Increased risk of digoxin toxicity.
- Kidney disease—Use with caution. The effects may be increased because of slower removal from the body.
- Ventricular fibrillation (heart rhythm problem)—Should not be used in patients with this condition.
Understand the Dosage
The information provided is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist before using this medication.
What is the dose of Digoxin for an adult?
Usual Adult Dose for Congestive Heart Failure
Rapid Digitalization with a Loading Dose:
Peak digoxin body stores of 8 to 12 mcg/kg generally provide a therapeutic effect with minimum risk of toxicity in most patients with heart failure and normal sinus rhythm.
The loading dose should be administered in several fractions, with approximately half the total given as the first dose. Additional fractions of the total dose may be given at 6 to 8 hour intervals. Careful assessment of the patient’s clinical response should be considered before each additional dose. If the patient’s response necessitates a change from the calculated loading dose of digoxin, then calculation of the maintenance dose should be based upon the amount actually given.
Initial: 500 to 750 mcg usually produces a detectable effect in 0.5 to 2 hours with a maximal effect in 2 to 6 hours. Additional doses of 125 to 375 mcg may be given at 6 to 8 hour intervals until clinical evidence of an adequate effect is noted. The usual amount of digoxin tablets that a 70 kg patient requires to achieve 8 to 12 mcg/kg peak body stores is 750 to 1250 mcg.
Initial: 400 to 600 mcg of digoxin capsules generally produces a detectable effect in 0.5 to 2 hours with a maximal effect in 2 to 6 hours. Additional doses of 100 to 300 mcg may be given cautiously at 6 to 8 hour intervals until clinical evidence of an adequate effect is noted. The usual amount of digoxin capsules that a 70 kg patient requires to achieve 8 to 12 mcg/kg peak body stores is 600 to 1000 mcg.
Initial: 400 to 600 mcg of digoxin intravenously usually produces a detectable effect in 5 to 30 minutes with a maximal effect in 1 to 4 hours. Additional doses of 100 to 300 mcg may be given cautiously at 6 to 8 hour intervals until clinical evidence of an adequate effect is noted. The usual amount of digoxin injection that a 70 kg patient requires to achieve 8 to 12 mcg/kg peak body stores is 600 to 1000 mcg. The injectable route is frequently used to achieve rapid digitalization, with conversion to digoxin tablets or digoxin capsules for maintenance therapy.
The doses of digoxin tablets used in controlled trials in patients with heart failure have ranged from 125 to 500 mcg once daily. In these studies, the digoxin dose has been generally titrated according to the patient’s age, lean body weight, and renal function. Therapy is generally initiated at a dose of 250 mcg once daily in patients under age 70 with good renal function.
Usual Adult Dose for Atrial Fibrillation
Peak digoxin body stores larger than the 8 to 12 mcg/kg required for most patients with heart failure and normal sinus rhythm have been used for control of ventricular rate in patients with atrial fibrillation. Doses of digoxin used for the treatment of chronic atrial fibrillation should be titrated to the minimum dose that achieves the desired ventricular rate control without causing undesirable side effects.
What is the dose of Digoxin for a child?
Usual Pediatric Dose for Atrial Fibrillation
Do not give full total digitalizing dose at once. Administer loading doses in several portions, give roughly half the total as the first dose. Give additional fractions of the total dose at 6 to 8 hour intervals (oral) or 4 to 8 hour intervals (parenteral). Divided daily dosing is recommended for infants and young children under 10 years of age.
Parenteral administration should be used only when the need for rapid digitalization is urgent or when the drug cannot be taken orally. Intravenous administration is preferred over intramuscular injection as it can lead to severe pain at the injection site. If it is necessary to administer the drug by the intramuscular route, it should be injected deep into the muscle followed by massage. No more than 500 mcg should be injected into a single site.
Calculated doses should be based on lean body weight.
Digitalizing (Loading) dose: Oral elixir: 20 to 30 mcg/kg; Intravenous: 15 to 25 mcg/kg
Maintenance dose: oral 5 to 7.5 mcg/kg; intravenous 4 to 6 mcg/kg
Digitalizing (Loading) dose: Oral elixir: 25 to 35 mcg/kg; Intravenous: 20 to 30 mcg/kg
Maintenance dose: oral 6 to 10 mcg/kg; intravenous 5 to 8 mcg/kg
Digitalizing (Loading) dose: Oral elixir: 35 to 60 mcg/kg; Intravenous: 30 to 50 mcg/kg
Maintenance dose: 10 to 15 mcg/kg oral; intravenous 7.5 to 12 mcg/kg
3 to 5 years:
Digitalizing (Loading) dose: Oral elixir: 30 to 40 mcg/kg; Intravenous: 25 to 35 mcg/kg
Maintenance dose: oral 7.5 to 10 mcg/kg; intravenous 6 to 9 mcg/kg
6 to 10 years:
Digitalizing (Loading) dose: Oral elixir: 20 to 35 mcg/kg; Intravenous: 15 to 30 mcg/kg
Maintenance dose: oral 5 to 10 mcg/kg; intravenous 4 to 8 mcg/kg
11 years and older:
Digitalizing (Loading) dose: Oral elixir: 10 to 15 mcg/kg; Intravenous: 8 to 12 mcg/kg
Maintenance dose: oral 2.5 to 5 mcg/kg; intravenous 2 to 3 mcg/kg
How is digoxin available?
Digoxin is available in the following dosage forms and strengths:
Lanoxin: 0.25 mg/mL (2 mL)
Lanoxin Pediatric: 0.1 mg/mL (1 mL)
Generic: 0.25 mg/mL (1 mL, 2 mL)
Generic: 0.05 mg/mL (60 mL)
Digox: 0.125 mg
Digox: 0.25 mg
Lanoxin: 0.125 mg
Lanoxin: 0.25 mg
Generic: 0.125 mg, 0.25 mg
Dosage Form, Canada:
Apo-Digoxin: 62.5 mcg, 125 mcg, 250 mcg
What should I do in case of an emergency or overdose?
In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.
What should I do if I miss a dose?
If you miss a dose of digoxin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Review Date: May 30, 2016 | Last Modified: January 4, 2017
Digoxin http://www.webmd.com/drugs/2/drug-4358/digoxin- oral/details. Accessed July 16, 2016.
Digoxin http://www.mayoclinic.org/drugs-supplements/digoxin- oral-route/description/drg-20072646. Accessed July 16, 2016.
Digoxin https://www.drugs.com/digoxin.html. Accessed July 16, 2016.