Structure

In 1 tablet contains 0.25 mg active substance digoxin .

A 1 ml solution contains an active substance in an amount of 0.25 mg.

Additional elements are: glycerin, ethanol, sodium phosphate, citric acid, injection water.

Digoxin release form

Produced in the form of a solution for injections and in a tablet form.

pharmachologic effect

Heart glycoside.

Pharmacodynamics and pharmacokinetics

Consider the mechanism of the drug action.

Preparation of plant origin, digoxin is obtained from woolly ingredient (Digitalis). Has pronounced cardiotonic effect (Positive inotropic effect, increasing the contractile ability of the heart muscle due to an increase in the concentration of calcium ions in cardiomyocytes), due to which he increases the impact volume of blood and a minute volume. Reduces the need of myocardial cells in oxygen.

In addition, it has a negative drromotropic and negative chronotropic effect, that is, it reduces the frequency of electrical pulse generation with a sinus node and the rate of the pulse through an atrioventricular conductive heart system. Also affects the aortic arc receptors and increases activity wandering nervewhat also slows the activity sinoatrial node .

Due to these mechanisms, it is possible to achieve a reduction in the heart rate in the rigging (supraventricular) tachyarhyrahythmias (paroxysmal or permanent form of atrial tachyarhythmias, atrial trembles).

With the pronounced insufficiency of the function of the heart and signs of stagnation on the large and small circles of blood circulation, the drug has indirect Vasodilatory action What is manifested in a decrease in the overall resistance of the peripheral vascular channel and reduce the severity of shortness of breath and peripheral edema.

It is accepted inside, 70% of the active substance is absorbed into the gastrointestinal tract, after receiving the limit concentration is achieved in the range from two to 6 hours. Parallel meal leads to some increase in suction time. The exceptions are products rich in vegetable fiber - in this case, part of the active substance is adsorbed by food fibers and becomes unavailable.

It has the property to accumulate in liquids and tissues, including myocardium, which is used in determining the application scheme: the effect of the drug is calculated not at the maximum concentration of the substance in the plasma, but by content at the moment of the equilibrium state of pharmacokinetics.

50-70% preparations are excreted by kidneys, severe pathology of this organ can contribute to the accumulation of digoxin in the body. The half-life reaches two days.

Indications for the use of Digoxin

What is the tablets and the solution usually apply?

Indications for the use of digoxin are violations heart Rhythm () of a sufficient nature (paroxysmal flickering tachyarhythmia, Atrial tremble , permanent cleaning Tahiaritmia ).

Medication is included in the treatment regimen chronic insufficiency The hearts of the third and fourth functional class, and also applied with second-class CHN, if severe clinical manifestations are diagnosed.

Contraindications

Direct contraindications for drug assignments are signs of glycoside intoxication, hypersensitivity to digoxin, wolf Parkinson-White Syndrome , second degree and complete atrioventricular blockade, bradycardia .

It is impossible to assign a medication with such manifestations ischemic Disease hearts unstable and acute period.

Contraindicated drug when isolated mitral stenosis .

Heart failure diastolic type (with tamponade Heart , P. constrictive pericardis , P. amyloidosis of the heart When cardiomyopathy) is also a contraindication to the appointment of digoxin.

Pronounced dilatation of heart departments , lack of kidney and hepatic parenchyma, myocardial inflammation, hypertrophy interventricular partition, subiutal Stenosis , ventricular tachyrhythmias - with these states, the use of medication is unacceptable.

Side effects

First of all, it is necessary to pay attention to the possible side effects from the cardiovascular system, as they may be the first signs of developing glycosidic intoxication .

Such symptoms include the slowdown in atrioventricular conductivity and, as a result, the deceleration of the rhythm (bradycardia), the appearance of heterotropic foci of the myocardial excitation, manifested in the development of ventricular arrhythmias ( extrasystole ) I. fibrillation of ventricles .

Easeless side effects do not represent, unlike the intracardiac, the threat of the patient's life. These include signs of violation of the function of the digestive tract (nausea, pain in the stomach, vomiting, and), nervous system (, or psychosis, violation of work visual analyzer in the form of flies in front of the eyes, etc.).

From the side of the blood there may be a violation of the morphological picture in the form of thrombocytopenia , And it will appear with petechs on the skin.

It is important to remember that the fatal outcome is possible when overdose.

Interaction

The medication cannot be combined with alkalis, with acids, with salts of heavy metals and with tanning substances. When used with diuretics, insulin, calcium salts, sympathomimetics, glucocorticosteroids The risk of glycosidic intoxication symptoms increases.

In combination with quinidine, amiodaron And there is an increase in blood digoxin in the blood. County inhibits the excretion of the active substance. The calcium channel blocker reduces the pace of elimination of digoxin from the body by the kidneys, which leads to an increase in the concentration of the heart glycoside. This action of verapamil is gradually leveled by prolonged joint adoption of drugs (more than six weeks).

The combination with increases the likelihood of the development of glycosides overdose due to hypokalemia that provokes amphotericin V. Hypercalcemia increases the susceptibility of cardiomyocytes to cardiac glycosides, and therefore should not be resorted to intravenous administration Calcium preparations to patients who take heart glycosides. The simultaneous reception of digoxin in combination with phenytio increases the likelihood of ventricular arrhythmias.

Reduce the concentration and effectiveness of the medication phenylbutazon and preparations of a group of barbiturates. Also reduced therapeutic effect Preparations of potassium, preparations that reduce the acidity of gastric juice, metoclopramid . When combined with erythromycin and the content of glycoside in the patient's plasma is growing. Simultaneous reception of medication with cholestipol, And magnesium laxatives leads to a deterioration in the absorption of the drug in the intestine, as a result of which there is a decrease in the number of digoxin in the body. Glycosides accelerates with a combined reception with rifampicin and sulfosalazine.

Terms of sale

Requires a recipe.

Storage conditions

In an inaccessible place at a temperature of 15-30 degrees Celsius.

Shelf life

Not more than three years.

special instructions

IN pediatric practice Tableted form is not used.

Digoxin recipe on Latin:

RP. Digoxini 0.00025
D. T. d. N 30 in Tabul.
S. 1 tab. 1 time a day 30 minutes before meals.

MNH according to the Director of Vidal: Digoxin.

During pregnancy and lactation

Influence drug The fruit in clinical studies has not been studied, but the drug is able to overcome hematoplazent barrier And get into the body of the fetus. Digoxin is prescribed only by emergency testimony.

If a nursing mother takes this medicine, the child should constantly monitor the heart rate.

Analogs of Digoxin

Coincidences on the ATX 4 level code:

There are no direct analogs of digoxin. Similar are drugs Novodigal and.

Name:

Digoxin (Digoxin)

Pharmacological
act:

Digoxin is a highly vigorous heart glycoside, the drug has a vasodilatory, an inotropic effect, also has a small soft diuretic effect. The drug reduces heart rate, increases the impact volume of the heart, increases the systolic volume of the heart, reduces the atrioventricular conductivity. The drug is extracted from a sparking woolly plant. After taking inside the drug quickly and almost completely absorbed from the gastrointestinal tract ...

Indications K.
application:

Digoxin is used chronic form cardiovascular insufficiency, fibrillation and fluttering atrial, takhiaritimia, clear arrhythmia, paroxysmal tachycardia ...

Mode of application:

The drug is used inside (orally), the dosage and duration of treatment is determined by the attending physician and is individual. Motherwise dose The preparation is 0.25 mg (one tablet). Reception The drug on the first day is carried out in this dosage four to five times a day, equal intervals between the drugs should be observed. Wherein daily dose It should not exceed 1-1.25 mg of the drug, on the second day they are prescribed the same one-time dosage, but the number of receptions of the day is from one to three. Depending on the resulting effect from receiving the drug, the dosage can be increased or decreased ...

Side effects:

Among possible side effectswhich may occur from the reception of digoxin allocate: nausea, vomiting, change of heart rate, petechia, apathy, headaches, feeling of fatigue, depressive condition, chair disorder (diarrhea), light-friendly, psychosis, thrombocytopenia, diplopy, lowering appetite, anorexia, disorder Visceral blood circulation, light-free, neuralgia, confusion of consciousness, allergic reactions ...

Contraindications:

The drug is not used in violations of the heart rhythm, unstable angina, mitral stenosis, inxication of glycosides, the presence of increased sensitivity to the components of the drug, subaportal hypertrophic stenosis, heart tamponade, myocardial infarction ...

Pregnancy:

The use of digoxin during pregnancy is possible only in cases where the potential benefit for the mother exceeds the potential risk for the child, when conducting clinical studies The teratogenic effect of the drug was not revealed ...

Due to its availability and effectiveness in the fight against heart disease, Digoxin is popular with consumers and gets wonderful reviews. Consider the principle of the impact of medication, instruction, composition, application and dosage.

The most common and frequently used form of the release of digoxin are pills taken orally. According to the instructions for use, these are white dragees, a flat cylindrical configuration. Each tablet preparation contains 250 μg of the main active substance - digoxin.

Dragee is painted in blisters of 10 pieces. In each package, the tool necessarily contains instructions for the use of Digoxin tablets.

Another method of packaging this medicine is cans from opaque glass or polymer. In each bottle, 50 dragee is packaged.

Instructions for use says, as part of digoxin, except for the main active component, contain:

• potato starch;
• sucrose;
• glucose;
• vaseline oil;
• talc;
• calcium stearate.

The presence of this list of auxiliary components depends on the plant producing medicines. Accordingly, the drug components may vary. Before use, the digoxin instruction should be carefully learned!

Pharmacological group

The instructions for use indicate that the Digoxin tablets refer to the pharmacological group of cardiotonic drugs.

According to the instructions for the use of pharmacodynamics of digoxin, it provides a positive inotropic effect that promotes the concentration of sodium ions inside the heart muscle cells and reduce the concentration of potassium ions. Through this, digoxin helps to increase the amount of calcium in cardiomyocytes.

The acting component of the Digoxin medication is absorbed into the blood through the walls of the gastrointestinal tract almost completely and immediately after the reception. It should be remembered that according to the instructions, the use of the drug simultaneously with the meal does not change the bioavailability of the digoxin, however, it turns out to be an effect on the absorption of active substances, leading to its slowdown.

In the tissues of the body, the digoxin is mainly distributed evenly, slightly more concentrating only in muscle cells of the heart.

Medication mechanism

According to the instructions for use, the drug Digoxin increases the functional activity of the heart. The mechanism of action of digoxin on the human body is as follows:

1. Inotropic action. Digoxin enhances the contractile ability of the heart muscle due to the increase in the concentration of calcium ions responsible for the reduction. The duration of the reduction itself decreases, and the period of muscle relaxation increases.
2. Negative chronotropic effect. The frequency of heartbeats is reduced by the effect of digoxin on the sinus assembly and the departments of the visceral nervous system.
3. Increases the counteractivity of the heart muscle, promotes the increase in blood volume.
4. Increases the tone of the heart muscle, as a result of which the dimensions of myocardium are reduced, the volume of oxygen necessary to it decreases
5. Increasing the activity of the wandering nerve, provides an antiarrhythmic effect.

What helps?

Based on the information specified in the instructions, the testimony for the use of digoxin are:

• II and III-IV functional class;
• flickering and tachiisistolic form.

Based on annotation to digoxin, it is part comprehensive treatment These heart disease with other medicines.

Flickering and fluttering atrial on ECG

Tablets Application Instructions

Regardless of the production plant for each pack, the Digoxin means is attached to the application. It is available and described in detail. general characteristics Digoxin medications, reception and dosage, as well as possible side effects and contraindications.

Before applying Digoxin tablets, it is necessary to thoroughly explore the instructions for use.

How to use?

The reception of the Digoxin tablets is performed orally, i.e., inside, followed by the use of a large amount of water. Based on the requirements of the instructions for use, drinking Digoxin tablets should be between meals takes. This will achieve the maximum suction rate of the active substance in the blood through the walls of the tract.

Throughout the course of treatment, you must follow the instructions of a specialist and stick to the diet.

Dosage

According to the instructions for use, the dosage of digoxin is titrated individually, based on the patient's condition, its age and weight.

Note! In the application instructions, it is said if other medicines for this were used before the Digoxin pharmacological group, then the dosage is subject to reduction. Be sure to inform the reception of other heartbreaks at the attending physician!

An adult man's application rate of digoxin is dictated by the required rates of achievement. According to the instructions for use, there are such basic diagrams of Digoxin:

1. In order to quickly digitalize (saturate the heart muscle with drugs, it is prescribed 0.75-1.25 mg on a day for a day. Then, according to the instructions, in the case of positive dynamics, a dose-supporting Digoxin drug is prescribed. In such a situation, the use of daily quantity of 0.125-0.75 mg is recommended.
2. In order to slowly saturate the cells by the active substance, the treatment initially begins with a supporting dose. In the instructions for use, it is indicated that digitalization occurs on average after 7 days of using the Digoxin medication.
3. With long heart failure, digoxin is used in small quantities. According to the instructions, the recommended daily amount of the active substance is up to 0.25 mg. If the patient's weight exceeds 90 kg, then the prescribed daily dose increases to 0.375 mg. People of old age, the number of active ingredients decreases to 0.0625-0.125 mg.

Important comments

According to the instructions for use, the treatment of heart failure digoxin must be carried out under the strict supervision of a specialist. If you have the need to use other heart glycosides (for example, stanfantine), they should be prescribed by the expiration of the day since the last Digoxin intake.

According to the instructions, the patient must be accurately followed by such instructions:

• admission of medication daily at a certain time of the day;
• when reducing heart abbreviations up to 60 strikes per minute, it is necessary to immediately consult a doctor;
• in the case of passing the reception of the next dose, it is necessary to take it at the first opportunity;
• tablets take according to the instructions of the doctor, it is forbidden to independently change the dosage;
• on the appearance side Effects should be a doctor;
• prior to the start of the surgical operation, it is important to notify a specialist about the use of digoxin.

People S. renal failure, weakened patients and persons of retirement age, as well as patients with implanted pacemakers, should be calculated to calculate the dosage of medication with extreme caution. The manifestation of toxic effects in this group of patients may occur in the case of consumption of even such a number of digoxin, which other people are perceived and transferred without any problems.

Side effects

According to the instructions for use, such side effects are likely when receiving digoxin:

• sinus bradycardia;
• atrial tachycardia;
• anorexia;
• nausea, vomiting;
• pain in the stomach;
• headache;
• disorientation;
• depression;
• color perception violations;
• gynecomastia;
• skin rashes;
• nasal bleeding;
• thrombocytopenia;
• eosinophilic.

According to the instructions, it is necessary to immediately stop using the Digoxin medication when the above-mentioned reactions of the body occurs.

Contraindications

Based on the instructions for use, the main contraindications to the use of digoxin are:

• individual intolerance to the components of the medication;
• wolf Parkinson-White syndrome;
• atrioventricular blockade of the II degree;
• electrolyte violations;
• hypothyroidism;
• myocarditis;
• renal and liver failure;
• all stages of obesity.

Important! The use of Digoxin tablets during pregnancy and lactation is allowed if the benefit for a woman exceeds the risk of complications in a child. It is necessary to strictly fulfill all the instructions of the attending physician.

Compatible with alcohol

Like all such cardiotonic medicines, it is not recommended to combine the reception of digoxin with alcohol. About their compatibility instructions for use does not give any information.

Powerful cardiovascular diseases should be borne in mind that in the prevailing majority of cases, the combination of alcoholic beverages and cardiac drugs leads to adverse consequences, such as excessive increase in pharmaco therapeutic effect, development of side and toxic actions Medication and alcohol, including the central nervous system.

To degree alcoholic intoxication Various factors affect:

• general condition of the patient;
• stage of development and gravity of the disease;
• the amount of ethanol and the time of its entry into the body;
• terms of use of medicines.

In case of exceeding the daily rate of digoxin intake, the use of alcoholic beverages can even lead to the death of the victim.

Opportunity overdose

On the manifestation of symptoms of overdose by digoxin affect the body's resistance to toxic compounds, the amount of the active substance, the foods from the diet of the victim.

Note! It is important to control the process of receiving heart preparations by the elderly relatives. By virtue of old age, they are able to forget about the number of digoxin tablets drinking and can take another, which will significantly exceed the permissible norm.

Poisoning

Incication of the active substance of the medication contributes to an instantaneous disorder of the gastrointestinal operation.

Digoxin poisoning, according to the instructions for use, is accompanied by the following symptomatics:

• reduction or absence of appetite;
• nausea;
• vomit;
• diarrhea;
• abdominal pain;
• violation of the conductivity of the heart;
• development of arrhythmia;
• drowsiness;
• delicious psychosis;
• reduced sharpness;
• disorder of color and dimensional perception of objects.

One of the important features of the improper use of Digoxin-based medicines is the appearance of manic-depressive syndrome.

In this case, the person is constantly experiencing a feeling of depression and devastation, unprecedented alarm and panic, insomnia develops. At such a condition of the patient must be paid attention to.

Important! In no case in no case should the victim should take medicines that facilitate pain and spasms. The use of such self-treatment can lead to complications and significantly complicates the process of diagnosing the disease.

Recovery after intoxication by digoxin will help strict adherence to the instructions of specialists, diet and mandatory control of compliance with the drinking regime. The body's resistance is raised by taking the vitamin complexes.

Death from the medicine

A possible consequence of an overdose of the drug is death from digoxin. In open sources, there is no information about the exact lethal dose, however, it is known that healthy man Symptoms of intoxication and overdose occur after the adoption of 0.05 mg of digoxin per 1 kg of human weight. For a person weighing 60 kg, this is 3 mg of digoxin or 12 tablets of 0.25 g. For a person with a cardiovascular disease, a mortal dose can be significantly lower.

The reception of antimicrobial agents or antibiotics simultaneously with the cardiotonic drug extremely increases the possibility of death from digoxin. These medicines contribute to the accumulation of the active substance in tissue cells, preventing it from the organism.

Another factor that promotes poisoning and possible fatal outcome is the reception of heart glycosides together with alcoholic beverages or medicines from one pharmacological group of Digoxin.

Digoxin - heart glycoside The average duration of action, obtained from the leaves of a flirty woolly. It has a positive inotropic effect, increases systolic and impact volumes of the heart, lengthens an effective refractor period, slows the AV conduction and uritia the heart rate. The use of digoxin in chronic heart failure leads to improving heart efficiency. Digoxin also has a moderate diuretic effect.

Pharmacokinetics

.
The drug is quickly and almost completely absorbed in gastrointestinal. The therapeutic concentration of digoxin in the blood is achieved after 1:00, the maximum concentration 1.5 hours after the reception.
The beginning of the action occurs after 30 minutes-2: 00 after reception.
Simultaneous intake with food reduces speed, but not a degree of absorption.
A minor amount is metabolized in the liver. In minor quantities penetrates through the placenta and in breast milk. Half-life averages 58 hours and depends on the age and health status of the patient (in people of young age - 36 hours, the summer - 68 hours), significantly increases with
renal failure. With Anururia, the half-life increases to several days. 50-70% of the drug is derived from the body with urine unchanged.

Indications for use

Indications for the use of the drug Digoxinthese are: congestive heart failure, flickering and fluttering atrial (for the regulation of heart rate), sufficientaricular paroxysmal tachycardia.

Mode of application

Pills Digoxinswallow, not chewing, drinking enough water.
It is recommended to use between meals. Doses of the drug establishes the doctor individually.
Adults and children over 10 years for fast digitalization to use 0.5-1 mg (2-4 tablets), and then every 6:00 to 0.25-0.75 mg for 2-3 days. After reaching the therapeutic effect, to apply in support doses of 0.125 * 0.5 mg per 1-2 reception per day. For slow digitalization, treatment immediately start with supporting doses of 0.125 * 0.5 mg per day in 1-2 reception. Saturation occurs approximately 1 week after the start of therapy. The maximum daily dose for adults is 1.5 mg (6 tablets). Children aged from 2 years to quickly digitalize digoxin to apply at the rate of 0.03-0.06 mg / kg body weight per day. For slow digitalization, apply in a dose of ¼ dose for rapid saturation. The maximum daily saturation dose is 0.75-1.5 mg, the maximum daily supporting dose is 0.125 * 0.5 mg. Children dose of saturation should be introduced into several techniques: approximately half of the total dose is given as the first dose and further - the shares of the total dose with an interval of 4-8 hours with an assessment of clinical responses to each next dose. If the clinical response of the patient requires a predetermined dose of saturation, the supporting dose is calculated based on the actually received saturation dose.
* If necessary, the use of digoxin in a dose of 0.125 mg should apply the drug with the possibility of such dosing. Patients with violations of the kidney function of the dose of digoxin should be reduced, since the main way of eliminating the kidneys. Summer age patients, given the age reduction of kidney function and low muscle mass, it is necessary to especially carefully select doses in order to prevent the development of toxic reactions and overdose.

Side effects

Blood system and lymphatic system: eosinophilia, thrombocytopenia, agranulocytosis.
Immune system: hypersensitivity reactions, including itching, hyperemia, rash, incl. erythematous, papulese, maculopapulous, vesiculous; Hermitage, swelling of quinque.
Endocrine system: Digoxin has estrogenic activity, so gynecomastia is possible in men with long-term use.
Mental violations: disorientation, confusion of consciousness, amnesia, depression, acute psychosis, nonsense, visual and auditory hallucinations, especially in elderly patients, has been reported by the court.
Nervous system: headache, neuralgia, increased fatigue, weakness, dizziness, drowsiness, bad dreams, anxiety, nervousness, excitement, apathy.
Bodies of view: Fucetitude view, light-free, halo effect, violation spectatic perception (perception of surrounding items in yellow, less often in green, red, blue, brown or white).
Cardiovascular system: Rhythm and conductivity violation ( sinus bradycardia, Sinoatrial blockade, monophocal or multifocal extrasystolia (especially bigemia, trigemine), lengthening the PR interval, depression of ST segment, ash blockade, paroxysmal atrial tachycardia, ventricular fibrillation, ventricular arrhythmia), occurrence or strengthening of heart failure.

These violations may be early signs of excessive doses of Digoxin.
Digestive tract: anorexia, nausea, vomiting, abdominal pain, diarrhea, especially in elderly patients; It has been reported on the excitation of visceral blood circulation, ischemia and intestinal necrosis. Adverse reactions Digoxin dose-dependent and usually develop with doses exceeding those that are necessary to achieve the therapeutic effect. Doses of the drug should be carefully chosen and adjust depending on the clinical state of the patient.

Contraindications

:
Contraindications for the use of the drug Digoxinare: increased sensitivity to digoxin, to other hearty glycosides or any of the components of the drug intoxication by drugs, which was previously applied; Arrhythmia caused by glycoside intoxication, a history of pronounced sinus bradycardia, an AJ blockade II-III degree, Adams-Stokes-Morgany syndrome; Carotid sinus syndrome; hypertrophic obstructive cardiomyopathy; Supported arrival arrhythmias associated with additional atrioventricular conductivity paths, incl. Wolf Parkinson-White syndrome; ventricular paroxysmal tachycardia / ventricular fibrillation; aneurysm of the thoracic aorta hypertrophic subaartal stenosis; isolated mitral stenosis; endocarditis, myocarditis, unstable angina, acute myocardial infarction, constrictive pericarditis, heart tamponade, hypercalcemia, hypokalemia.

Pregnancy

Information about the possibility of teratogenic action Digoxinabsent.
It should be borne in mind that digoxin penetrates through the placenta, the clearance during pregnancy increases. During pregnancy, the drug can be applied under the control of the doctor only when the expected benefit for the mother exceeds the potential risk to the fetus. Digoxin falls into breast milk in quantity, does not affect the child negatively (the concentration of digoxin in breast milk It is 0.6-0.9% of the concentration in the blood plasma). When applying digoxin breastfeeding, the cardiac abbreviation frequency should be monitored.

Interaction with other medicines

Digoxinit is a substrate for p-glycoprotein.
Preparations induce or inhibit p-glycoprotein, affect the pharmacokinetics of digoxin (on the level of absorption in the digestive tract, kidney clearance), changing its concentration in the blood.
Pharmacokinetic interactions.
Preparations that increase the concentration in the blood of digoxin\u003e 50%.
Amiodaron, Dramedaron, Flearinid, Dizineiramide, PropaPenon, County, Nitrindipine, Ranolazine, Ritonavir, Verapamil, Felodipine, Tiapamil - Domoz Digoxin should be reduced during their simultaneous use by 30-50%, continuing to monitor the level of digoxin in plasma blood.
Preparations that increase the blood concentration of Digoxin<50%. Карведилол, дилтиазем, нифедипин, никардипин, лерканидипин, рабепразол, телмисартана - следует измерить сывороточные концентрации дигоксина перед применением сопутствующей терапии. Уменьшить дозу дигоксина примерно на 15-30% и продолжить мониторинг. Препараты, повышающие концентрацию в крови дигоксина (величина неясна).
Alprazolam, diazepam, atorvastatin, azithromycin, clarithromycin, erythromycin, telithromycin, gentamicin, chloroquine, hydroxychloroquine, trimethoprim, cyclosporin, diclofenac, indomethacin, aspirin, ibuprofen, diphenoxylate, epoprostenol, esomeprazole, itraconazole, ketoconazole, lansoprazole, metformin, omeprazole, propantheline, Nefazodon, TRORODON, Topiramat, Spironolactone, Tetracycline - measurement of serum concentrations of digoxin before applying concomitant drugs. If necessary, reduce the dose of digoxin and continue monitoring. Preparations that reduce the concentration in the blood of digoxin. Akarbossa, Adrenaline (Epinephrine), Activated Coal, Antacid, Some Cytostatics, Cholestiramine, Bolf, Some Laxative, Nitroprusside, Hydralazine, Metoklopramide, Miglitol, Neomycin, Penicyllamine, Carbimazole, Rifampicin, Salbutamol, Sukralfat, Sulfasalazine
phenytoin, Barbiturates, Phenylbutazone, High Bran Food, Hypericum Preparations - Measurement of whey concentrations of digoxin before using concomitant drugs. Increase the dose of digoxin if necessary by 20-40% and continue monitoring.
Pharmacodynamic interactions.
Amphotericin, salts of lithium, acetasolamide, loop and thiazide diuretics: hypokalemia caused by these drugs can increase the cardiotoxicity of digoxin and the risk of developing arrhythmias. If necessary, you should assign potassium preparations, adjust the electrolyte imbalance. With the simultaneous use of diuretics with cardiac glycosides, the optimal dosage should be followed. You can periodically assign potassium-saving diuretics (spironolactone, triamtenen), eliminating hypokalemia and arrhythmia. However, hyponatremia may develop. Potassium preparations. Under the influence of potassium preparations, undesirable effects of heart glycosides are reduced. Corticosteroids, drugs corticotropin, carbenoxolone cause loss of potassium, sodium delay and fluid in the body. As a result, digoxin toxicity increases, the risk of developing arrhythmias and heart failure.
The condition of patients taking long corticosteroid courses should be carefully monitored. Calcium preparations, especially with rapid administration, can lead to serious arrhythmias in digitalized patients. Vitamin D and its analogues (for example, ergocalciferol), the terrparatide can increase the toxicity of the digoxin due to the increase in the concentration of calcium in the blood plasma.
Dfethylide increases the risk of Torsades De Pointes type arrhythmia.
Moracisin: Possible additional effects on cardiac conductivity, a significant lengthening of the Qt interval, which can lead to av blockade.
Sympathomometric means: adrenaline (epinephrine), norepinephrine, dopamine, selective β2 receptor agonists, including salbutamol, can increase the risk of developing arrhythmias.
Miorolaksanta (Edrofonius, Suxametonium, Panteronia, Tizanidine): It is possible to strengthen the arterial hypotension, excessive bradycardia and blockade due to the rapid removal of potassium from myocardial cells. Simultaneous use should be avoided.
Beta-adrenoblays, incl. Satolol, and calcium channel blockers increases the risk of pro-amateur events, an additive effect on the conductivity of the AV node can lead to bradycardia and the full blockade of the heart. Phenytoin: The introduction of phenytoin should not be used to treat digoxin-induced arrhythmia due to the risk of a heart stop.
Colchicine: It is possible to increase the risk of developing myopathy.
MEFLOKHIN: It is possible to increase the risk of developing bradycardia.
Ksanthin derivatives caffeine or theophylline preparations sometimes cause arrhythmias.
Aminazine and other phenothiazine derivatives: the action of cardiac glycosides decreases.
Anticholinesterase preparations: Strengthening bradycardia.
If necessary, it can be eliminated or weakened by the administration of atropine sulfate.

Overdose

Overdose drug Digoxindevelops gradually within a few hours.
Symptoms: from the cardiovascular system - arrhythmia, including bradycardia, blockade, ventricular tachycardia or extrasystole, ventricular fibrillation; From the digestive tract - anorexia, nausea, vomiting, diarrhea from the central nervous system and sense organs - headache, increased fatigue, dizziness, rarely - violation of the perception of colors, reducing visual acuity, scotoma, macro- and microfsy, very rarely - confusion Consciousness, synicopal states.
The most dangerous symptoms are violations of the rhythm due to the risk of death in the development of ventricular arrhythmias or cardiac blockade with asistol.
Treatment: washing the stomach, the reception of activated carbon, a whiffing or swiveraffin. In the occurrence of arrhythmia, it is intravenously dripping 2-2.4 g of potassium chloride with 10 julin in 500 ml of a 5% glucose solution (administration to stop with a serum concentration in serum in the range of 4-5.5 mmol / l). Means containing potassium are contraindicated in violation of the atrocadic conductivity. With pronounced bradycardia, the sulfate atropine solution is prescribed.
Showing oxygen therapy. As a disinfectant is also prescribed unitiol, ethylenediaminetetraacetate. Special. In case of hypokalemia, in the absence of a complete blockade of the heart, potassium preparations should be administered. With a complete blockade of the heart, it is carried out an electrocardialization. When arrhythms, apply lidocaine, procanamide, phenytoin, propranolol. When the Digoxin is overwhelmed, which threatens life, the introduction of leather antibodies through a membrane filter, which bind digoxin (Digoxin Immune Fab, Digitalis-Antidote Bm), 40 mg of the antidote is associated with approximately 0.6 mg of digoxin. With the overdose of digoxine dialysis and the exchange transfusion of blood is ineffective.

Storage conditions

In the original packaging at a temperature not higher than 25 ° C. Store in an inaccessible place for children.

Form release

Digoxin -pills.
Packaging: 20 tablets in a blister, 2 blisters in a pack.

Structure

1 Tablet Digoxincontains digoxin (in terms of 100% substance) 0.25 mg.
Auxiliary substances: microcrystalline cellulose, lactose, starch corn, calcium stearate.

Additionally

In treating Digoxinthe patient must be under the control of the doctor. With long therapy, the optimal individual dose of the drug is usually selected within 7-10 days. In cases where in the previous two weeks, the patient acted other heart glycosides, it is recommended to begin treatment with digoxin with smaller doses. If necessary, the use of stanfantine last is appointed no earlier than 24 hours after the discharge of digoxin.
It should be used with extreme caution: elderly patients - a tendency to reduce the function of kidney and low muscular mass in the elderly affects the pharmacokinetics of digoxin: higher whey levels of digoxin, elongation of the half-life period, so exists
increased risk of developing adverse reactions, cumulative effect and probability of overdose; weakened patients, patients with impaired kidney function, patients with an implanted pacemaker, since they have toxic effects can develop when applying doses that usually
well tolerated by other patients; with concomitant atrial fibrillation and heart failure to patients with thyroid disease - with a reduced thyroid function, the initial and supporting doses of digoxin must be reduced; With hyperthyroidism, there is relative digoxin resistance, as a result of which the dose can be increased.
During the treatment of thyrotoxicosis, the dose of digoxin should be reduced when the thyrotoxicosis is translated into a controlled state. The changes in the function of the thyroid gland may affect the sensitivity to digoxin, regardless of its concentration in the blood plasma patients with a short intestine syndrome or with Mal Absorption syndrome - due to impaired digoxin absorption, higher doses of the drug patients with severe respiratory diseases may be possible - increased myocardial sensitivity to glycosides ; Patients with lesions of the cardiovascular system during the disease Beri-take - is possible inadequate reaction to digoxin, if simultaneously not to treat the main deficiency of thiamine; In hypocalemia, hypernaliamia, hypercalcemia, hypernatremia, hypothyroidism, hypoxia, the "pulmonary" heart increases the risk of digitalistic intoxication, arrhythmias.
The electrolyte imbalance requires its correction. Such patients should avoid the use of digoxin in high one-time doses. Patients who are planned to hold cardioversion should stop receiving digoxin 1-2 days before the procedure if possible. If cardioversion is required, and digoxin is already given, it is desirable to apply the minimum efficient discharge. During the treatment, the Digoxin should regularly monitor ECG, kidney function (serum creatinine concentration), electrolyte concentrations (potassium, calcium, magnesium) in serum. Since digoxin slows down the synoatrile and AV conductivity, the use of therapeutic doses of digoxin can lead to the elongation of the PR interval and the depression of the ST segment to the ECG. The method of digoxin can lead to false-positive ST-T changes to the ECG during load tests. These electrophysiological effects reflect the expected effect of the drug and do not indicate its toxicity. During treatment, it is necessary to limit food eating that is difficult to digest and products containing pectins. Digoxin tablets contain lactose. Patients with rare hereditary problems of galactose intolerance, lactase deficiency or glucose-galactose malabsorption syndrome should not be taken.

Main settings

Name:	DIGOXIN
ATH code:	C01AA05 -

Name:

Digoxin (Digoxin)

Pharmachologic effect:

Refers to a group of cardiac glycosides. The drug is obtained from the medicinal plant of the Woolly (Digitalis Lana Ehrh.). It has the following actions: inotropic, vasodilatory and moderate diuretic.

Increases the impact and systolic volumes of the heart, increases the refractory period, reduces the atrioventricular conduction, reduces the frequency of abbreviations of the heart muscle. In the case of congestive phenomena, during cardiovascular failure, it has a pronounced vasculating effect. Digoxin has a soft diuretic effect, reduces the severity of edema, shortness of breath. In case of overdose, it is able to initiate an increase in the excitability of myocardium, resulting in disruption of the rhythm of the heart.

When receiving inside the digoxin quickly, almost entirely absorbed from the gastrointestinal tract. The bioavailability of the drug is 60-70%. 60 minutes after oral administration in the blood, the therapeutic concentration of the drug is already observed. Cmax in blood plasma is reached 1.5 hours after administration. The half-life of digoxin depends on several factors: possible changes in the functions of the kidneys, from age. In patients of young people, half-life is 36 hours, the elderly is 68 hours. Eliminated 80% of the drug by the kidneys unchanged.

With simultaneous meals and digoxin, there is a decrease in the absorption of the drug, but the degree of suction does not change. In the case of prevalence in food fibers (bran), the absorption of digoxin deteriorates significantly.

Indications for use:

Chronic cardiovascular failure (stagnation),

Tahiaritimia (paroxysmal supraventic) - at shimmer arrhythmia, atrial flication, paroxysmal tachycardia.

Application technique:

Dose Digoxin picks up the doctor individually. A single dose of the drug is 0.00025g (for adults) - 1 tablet of 0.25 mg. On the first day of therapy, 4-5 times / day are used with intervals equal to each other. The daily dose is 1-1.25 mg. The next day, the same one-time dose is prescribed, but 1-3 times / day. The positive effect is evaluated according to electrocardiography, respiratory functions, urination. Depending on this, the dosage of digoxin can or increase, or reduce. After the onset of the therapeutic effect, the drug is prescribed according to the scheme: 0.5-0.25-0.125 mg (in the morning - 2 tablets, at lunch - 1 tablet, at night - half a pill). For adults, the highest dose per day is 1.5 mg (0.0015 g).

During cardiovascular failure, digoxin is prescribed from receiving supporting (0.125-0.25 mg per day) dose. When arrhythmia, at the beginning of therapy, you can use higher dosages - 0.375-0.5 mg / day. In the sinus rhythm, digoxin is not used in high doses (0.25 mg / day).

In pediatrics, the selection of the dose is carried out individually. Approximate saturating daily dosage - 0.05-0.08 mg per kilogram of body weight. This dosage is used to quickly digitalize (1-2 days), medium (3-5 days) or slow (6-7 days).

Unwanted phenomena:

The cardiovascular system:

changes in the heart rhythm (overdose phenomena).

Gastrointestinal tract:

vomiting, nausea, decreased appetite, diarrhea.

Central nervous system:

fatigue, general weakness, apathy, headache, light-free, diplopia, depression, flickering of flies, psychosis.

Endocrine system:

gynecomastia with prolonged reception of the drug.

Blood and blood formation system:

petechia, thrombocytopenia.

Allergic reactions:

itching, urticaria.

Side effects are most often signs of deigitalis overdose.

Contraindications:

Digoxin is contraindicated in unstable angina, intoxication of glycosides, heart tamponade, heart rate disorders (ventricular fibrillation, pronounced bradycardia, atrioventricular blockade, extrasystolia, ventricular tachycardia), mitral stenosis (isolated), Wolf Parkinson-White Syndrome (WPW), individual hypersensitivity to Digoxin preparations, subaartal hypertrophic stenosis, myocardial infarction in acute stage.

During pregnancy:

This drug is capable of penetrating through the hematoplazent barrier, in the plasma of blood in the fetus is determined in the same concentrations as in a pregnant woman. Excreted with breast milk slightly. However, during lactation against the background of the reception of digoxin, heart rate monitoring is needed. The teratogenic potential in clinical studies was not detected, but digoxin for pregnant women must be prescribed only if the benefits of admission over the likely risks for the fetus or child are exceeded.

Interaction with other drugs:

Incompatible with metals salts, acids, alkali and tanning substances. When combining with diuretic, glucocorticosteroids, insulin, sympathomimetics, calcium salts, the likelihood of glycoside intoxication is increased.

In combination with quinidine, erythromycin, with amiodarone, verapamil is observed an increase in the concentration of the drug in the blood. County reduces digoxin removal, which increases its blood content.

The kidney clearance of digoxin can decrease with simultaneous reception of verapamila. However, this effect is reduced with a continuous reception of both drugs (5-6 weeks).

Both verapamil and quinidine can displace digoxin from the binding places, therefore, at the beginning of treatment, a sharp increase in the concentration of digoxin in blood plasma is possible. In continuation of the reception, the concentration of the drug is stabilized at a level, which depends on the clearance of digitalis.

In combination with amphotericin, the risk of overdose is increasing due to the fact that amphotericin in causes hypokalemia.

An increase in the concentration of calcium in serum increases the sensitivity of the heart muscle, so calcium preparations should not be administered intravenously with patients receiving cardiac glycosides.

When combined with reserp pozynitin, propranolol rinsing the risk of developing arrhythmia.

Reduce the concentration in the blood of digoxin phenylbutazone and the preparations of the barbituro row (as a result, its effectiveness is reduced).

Reduce the therapeutic effect of antacids, potassium preparations, metoclopramide and neomycin.

When combinations with gentamicin, erythromycin, the concentration of the drug in the blood plasma increases.

Simultaneous reception with cholestyramine, cholestipol, magnesium laxatives, antacids, metoclopramide suction of digoxin from the gastrointestinal tract decreases (there is also a decrease in the concentration of digoxin in the blood).

The metabolism of the drug is enhanced with a combination with sulfosalazine and rifampicin, as a result, a decrease in the concentration of digoxin in the blood plasma is observed.

Overdose:

Overdose symptoms appear during glycoside intoxication. It is characterized by the appearance of sinus bradycardia, ventricular extrasystole in the type of bigeninia, atrial tachycardia, fibrillation of ventricles, slowing the atrioventricular conduction, atrioventricular blockade. Among the symptoms of glycoside intoxication are extraordinary: dyspepsia (diarrhea, vomiting or nausea, anorexia), weakening of memory, drowsiness, pain in the head, weakness in muscles, erectile dysfunction, gynecomastia, psychosis, anxiety, euphoria, flickering "flies" before your eyes, Xantopsy, cattle, reduction of visual acuity, micro- and macroyscia.

In old age, the confidence of consciousness may be observed.

If the symptoms are negligible - it is necessary to reduce the dose of digoxin. In the case of progression or pronounced side effects, there is a small break (if the drug should be continued). The duration of the interruption depends on the severity of symptoms of intoxication by digoxin.

In the case of acute poisoning, digoxin is prescribed to wash the stomach with water with the addition of coal of activated or enterosorbents, in the future these preparations are administered orally. Prescribed laxatives (salt: magnesium sulfate, sodium sulfate - dissolve 15-30.0 g of saline laxative in 250 ml of warm water).

In the case of development, arrhythmia can be stopped by intravenous drip infusion of potassium chloride (2-2.4 g) with the addition of insulin (10 units). These components are added in 500 ml of dextrose and administered to the concentration of potassium in serum 3 MEQ / l. Potassium administration is categorically contraindicated in disruption of atrioventricular conduction. If the antiarrhythmic effect failed to achieve, it is possible to introduce intravenously phenytoin in the calculation of 0.0005 g / kg of the patient's weight, the introduction to be carried out with an interval of 1-2 hours. Atropine sulfate is shown in pronounced bradycardia. Also appointed hydroxiotherapy, under hypotension - drainage preparations. Unitiol can be used as an antidote.

The form of the drug:

White tablets are 0.00025 mg, in a cardboard package contains 2 blisters for 20 tablets each.

Storage conditions:

Store no more than 5 years at a temperature not higher than 25 ° C.

Structure:

Active ingredient: Digoxin.

Inactive Ingredients: Talc, Glucose, Sugar, Vaseline Oil, Starch, Calcium Stearate.

Additionally:

When the digoxin is prescribed, the patient must be under the control of medical staff. With long-term treatment, the optimal dosage is selected individually for 7-10 days. It should be remembered that the interval between therapeutic and toxic doses of Digoxin is very insignificant. Consequently, the patient must strictly follow the prescriptions of the doctor.

The risk of intoxication by digitalis increases with a decrease in the level of potassium in the blood, with strong dilatation of myocardium, alkalosis, pulmonary heart, myocarditis, in elderly patients. The risk of intoxication by digoxin is also asgraded in the case of hypercalcemia, hypomagnemiology, hypernatremia, hypothyroidism.

If necessary, the latter is necessary for the latter, the latter is prescribed no earlier than the day after the last Digoxin intake. In the case of a combination of digoxin saluretics, potassium preparations must be prescribed, since its decrease in blood will potentiate the toxic effects of digitalis.

In the case of renal failure, it is necessary to reduce the dose of the drug (25-75% of the usual dose - with glomerular filtration less than 50 ml / min, 10-25% of the usual dose - with glomerular filtration less than 10 ml / min).

During the reception of digoxin, regular monitoring of electrocardiography and the determination of electrolyte balance (magnesium, potassium, calcium) in serum is required.

Patients warn that eating rich in hard-plated plant fibers and pectins reduce the effects of digoxin.

Preparations of similar action:

Atsetildigoksin beta (Acetyldigoxinbeta) Digitalis purple leaves powder (PulvisfoliorumDigitalis) drops Landysheva-valeric with sodium bromide (GuttaeConvallariaeetValeriani cumNatriibromidi) drops Landysheva-valeric with adonizid and sodium bromide (Guttae Convallariae et Valeriani cum Adonisidi et Natrii bromidi) drops Landysheva-valeric with adonizid (Guttae Convallariae et Valeriani Cum Adonisidi)

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