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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.01.01  Expand sub section  Cardiac glycosides
 note 
  • Digoxin controls the ventricular rate in patients with persistent or permanent atrial fibrillation, especially when it occurs with heart failure. It is also used in the treatment of supraventricular tachycardias and atrial flutter but not ventricular arrhythmias.
  • Digoxin should only be considered as monotherapy for permanent AF in predominantly sedentary patients who need treatment for rate control.
  • A loading dose may be given on initiation of therapy to achieve a rapid therapeutic effect; otherwise it will take about a week to obtain maximal effect. An oral loading dose is often satisfactory but for a more rapid onset it can be given by intravenous infusion. Even with intravenous administration, response may take many hours; persistence of tachycardia is therefore not an indication for exceeding the recommended dose.
  • In patients with heart failure who are in sinus rhythm a loading dose is not required, and a satisfactory plasma-digoxin concentration can be achieved over a period of about a week.
  • Intramuscular injection should be avoided as it is painful and absorption is variable.
  • Age and renal function are key determinants of the dosing regimen.
Digoxin
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