Lanoxin Tablet

Digoxin
0.25mg
Glaxo SmithKline Pharmaceuticals Ltd.
Pack size 1
Dispensing mode
Source
Agent
Retail Price 2.33 NPR

Indications

Lanoxin Tablet is used for: Heart failure, Supraventricular arrhythmias, Atrial fibrillation and Atrial flutter

Adult Dose

Atrial Fibrillation Rapid digitalizing (loading-dose) regimen PO: 10-15 mcg/kg total loading dose; administer 50% initially; then may cautiously give 1/4 the loading dose q6-8hr twice; peform careful assessment of clinical response and toxicity before each dose Maintenance PO: 3.4-5.1 mcg/kg/day or 0.125-0.5 mg/day PO; may increase dose every 2 weeks based on clinical response, serum drug levels, and toxicity Heart Failure As per ACCF/AHA guidelines, a loading dose to initiate digoxin therapy in patients with heart failure is not necessary 0.125-0.25 mg PO/IV qDay; higher doses including 0.375-0.5 mg/day rarely needed Use lower end of dosing (0.125 mg/day) in patients with low lean body mass

Child Dose

Heart Failure/Atrial Fibrillation Use doses at the lower end of the spectrm when treating heart failure Reduce dose by 20-25% when changing from oral formulation or IM to IV therapy Premature neonate PO: 1st loading dose, 10-15 mcg/kg; 2nd and 3rd loading doses, 5-7.5 mcg/kg q6-8hr for 2 doses; maintenance: 5-7.5 mcg/kg/day divided q12hr Full-term neonate PO: 1st loading dose, 12.5-17.5 mcg/kg; 2nd and 3rd loading doses, 6.25-8.75 mcg/kg q6-8hr for 2 doses; maintenance: 6-10 mcg/kg/day divided q12hr Infants & children 1-24 months PO: 1st loading dose, 17.5-30 mcg/kg; 2nd and 3rd loading doses, 8.75-15 mcg/kg q6-8hr for 2 doses; maintenance: 10-15 mcg/kg/day divided q12hr 2-5 years PO: 1st loading dose, 15-20 mcg/kg; 2nd and 3rd loading doses, 8.75-10 mcg/kg q6-8hr for 2 doses; maintenance: 7.5-10 mcg/kg/day divided q12hr 5-10 years PO: 1st loading dose, 10-17.5 mcg/kg; 2nd and 3rd loading doses, 5-8.75 mcg/kg q6-8hr for 2 doses; maintenance: 5-10 mcg/kg/day divided q12hr >10 years & <100 kg PO: 1st loading dose, 5-7.5 mcg/kg; 2nd and 3rd loading doses, 2.5-3.75 mcg/kg q6-8hr for 2 doses; maintenance: 2.5-5 mcg/kg/day

Renal Dose

Use lower end of dosing (0.125 mg/day) in patients with impaired renal function

Administration

May be taken with or without food.

Contra Indications

Digitalis toxicity, ventricular tachycardia/fibrillation, obstructive cardiomyopathy. Arrhythmias due to accessory pathways (e.g. Wolff-Parkinson-White syndrome).

Precautions

Cardiac dysrhythmias, hypokalaemia, hypertension, IHD, hypercalcaemia, hypomagnesaemia, electroconversion, chronic cor pulmonale, aortic valve disease, acute myocarditis, congestive cardiomyopathies, constrictive pericarditis, heart block, elderly, renal impairment, abnormalities in thyroid function; pregnancy. IV digoxin can only be given to patients who have not received cardiac glycosides in the preceding 2 wk. Lactation: Drug enters breast milk; use with caution (American Academy of Pediatrics committee states, "compatible with nursing")

Pregnancy-Lactation

Interactions

Effectiveness reduced by phenytoin, neomycin, sulphasalazine, kaolin, pectin, antacids and in patients receiving radiotherapy. Metoclopramide may alter the absorption of solid dosage forms of digoxin. Blood levels increased by calcium channel blockers, spironolactone, quinidine and calcium salts. Potentially Fatal: Electrolyte imbalances such as hypokalaemia and hypomagnesemia (e.g. admin of potassium-losing diuretics, corticosteroids) can increase the risk of cardiac toxicity.

Adverse Effects

Side effects of Digoxin : 1-10% Dizziness (4.9%),Mental disturbances (4.1%),Diarrhea (3.2%),Headache (3.2%),Nausea (3.2%),Vomiting (1.6%),Maculopapular rash (1.6%) <1% Anorexia,Cardiac dysrhythmia,Arrhythmia in children (consider a toxicity) Frequency Not Defined Visual disturbance (blurred or yellow vision),Heart block (1°/2°/3°),Asystole,Tachycardia Potentially Fatal: Cardiac arrhythmias in combination with heart block.

Mechanism of Action

Digoxin is a cardiac glycoside which has positive inotropic activity characterized by an increase in the force of myocardial contraction. It also reduces the conductivity of the heart through the atrioventricular (AV) node. Digoxin also exerts direct action on vascular smooth muscle and indirect effects mediated primarily by the autonomic nervous system and an increase in vagal activity.

Note

Lanoxin 0.25mg Tablet manufactured by Glaxo SmithKline Pharmaceuticals Ltd.. Its generic name is Digoxin. Lanoxin is availble in Nepal. Farmaco Nepal drug index information on Lanoxin Tablet is not intended for diagnosis, medical advice or treatment; neither intended to be a substitute for the exercise of professional judgment.

Some other brands of Digoxin :