Indications

• Rate Control of AV Nodal-Mediated Arrhythmias
  • Atrial Fibrillation with Rapid Ventricular Response (see Atrial Fibrillation, [[Atrial Fibrillation]])
  • Supraventricular Tachycardia (SVT) with Rapid Ventricular Response (see Supraventricular Tachycardia, [[Supraventricular Tachycardia]])
• Systolic Congestive Heart Failure (CHF) (see Congestive Heart Failure, [[Congestive Heart Failure]])

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Contraindications

Atrioventricular Heart Blocks

• First Degree Atrioventricular Block (First Degree Heart Block) (see First Degree Atrioventricular Block, [[First Degree Atrioventricular Block]]): with P-R interval ≥0.24 sec
• Second Degree Atrioventricular Block-Mobitz Type I (Wenckebach) (see Second Degree Atrioventricular Block-Mobitz Type I, [[Second Degree Atrioventricular Block-Mobitz Type I]])
• Second Degree Atrioventricular Block-Mobitz Type II (see Second Degree Atrioventricular Block-Mobitz Type II, [[Second Degree Atrioventricular Block-Mobitz Type II]])
• Third Degree Atrioventricular Block (Third Degree Heart Block, Complete Heart Block) (see Third Degree Atrioventricular Block, [[Third Degree Atrioventricular Block]])

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Pharmacology

• xxx
• Role of Hypercalcemia (see Hypercalcemia, [[Hypercalcemia]]): enhances sensitivity to digoxin (increases digoxin toxicity)

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Administration

• PO: 0.125-0.25 mg qday
• IV
  • Load: 0.25 mg q2 hrs x 2 doses (total dose = 0.5 mg)
  • Maintenance: 0.125-0.25 mg qday
• Monitor: follow digoxin level

Dose-Adjustment

• Hepatic
• Renal

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Adverse Effects

Cardiovascular Adverse Effects

Atrioventricular Heart Blocks

• First Degree Atrioventricular Block (First Degree Heart Block) (see First Degree Atrioventricular Block, [[First Degree Atrioventricular Block]])
• Second Degree Atrioventricular Block-Mobitz Type I (Wenckebach) (see Second Degree Atrioventricular Block-Mobitz Type I, [[Second Degree Atrioventricular Block-Mobitz Type I]])
• Second Degree Atrioventricular Block-Mobitz Type II (see Second Degree Atrioventricular Block-Mobitz Type II, [[Second Degree Atrioventricular Block-Mobitz Type II]])
• Third Degree Atrioventricular Block (Third Degree Heart Block, Complete Heart Block) (see Third Degree Atrioventricular Block, [[Third Degree Atrioventricular Block]])

QT Prolongation with Definite Association with Torsade (see Torsade, [[Torsade]])

• xxx

Bradycardia (see Bradycardia, [[Bradycardia]])

• xxxx

Other Adverse Effects

• xxxx
• xxxx
• xxxx

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Digoxin Intoxication

Diagnosis

• Digoxin Level: elevated

Clinical Manifestations

Cardiovascular Manifestations

• Atrioventricular Heart Blocks
  • First Degree Atrioventricular Block (First Degree Heart Block) (see First Degree Atrioventricular Block, [[First Degree Atrioventricular Block]])
  • Second Degree Atrioventricular Block-Mobitz Type I (Wenckebach) (see Second Degree Atrioventricular Block-Mobitz Type I, [[Second Degree Atrioventricular Block-Mobitz Type I]])
  • Second Degree Atrioventricular Block-Mobitz Type II (see Second Degree Atrioventricular Block-Mobitz Type II, [[Second Degree Atrioventricular Block-Mobitz Type II]])
  • Third Degree Atrioventricular Block (Third Degree Heart Block, Complete Heart Block) (see Third Degree Atrioventricular Block, [[Third Degree Atrioventricular Block]])

Bradycardia (see Bradycardia, [[Bradycardia]])

• xxx

Gastrointestinal Manifestations

• Nausea/Vomiting (see Nausea and Vomiting, [[Nausea and Vomiting]])

Neurologic Manifestations

• Yellow Vision

Treatment

• Discontinue Digoxin: necessary
• Treat Hypokalemia: if present
• Digibind (see Digibind, [[Digibind]])
  • Indications
    • Arrhythmias
    • xxx

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References

• xxxx