Digoxin
Također poznato kao: Lanoxin, Cardoxin, Lanoxin PG
Digoxin is a potent heart medication used to help the heart pump more effectively and control irregular heartbeats. * **Strict Dosing:** Give this medication exactly as prescribed. Do not change the dose or stop the medication without consulting your veterinarian, as the difference between a helpful dose and a toxic dose is very small. * **Watch for Toxicity:** Contact your veterinarian immediately if your pet shows any signs of toxicity, which often start with gastrointestinal upset. Watch for **loss of appetite, vomiting, diarrhea, lethargy, depression, or changes in behavior**. * **Missed Doses:** If you miss a dose, do not double up on the next dose. Give the next dose at the regularly scheduled time. * **Monitoring:** Your pet will need regular blood tests to check the level of digoxin in their blood, as well as kidney function and electrolyte levels, to ensure the dose remains safe and effective.
Dosage must be set by your veterinarian for your specific pet. Never give human medication or another pet’s prescription without veterinary guidance.
Veterinary professional? See the full dosing-by-species reference on VetSheet →
What it is used for
- Dilated cardiomyopathy or advanced atrioventricular valve insufficiency
- Starting dose for normal cats weighing less than 3 kg
- Starting dose for normal cats weighing 3 to 6 kg
- Starting dose for normal cats weighing more than 6 kg
- Management of supraventricular tachyarrhythmias
- Management of supraventricular tachyarrhythmias (Emergency/Rare)
- Dilated cardiomyopathy
- Maintenance
- Dilated cardiomyopathy long-term maintenance
- Loading dose
- Maintenance Dose
- Emergency stabilization
- Dilated cardiomyopathy in Hamsters
- Normalize atrial rate
- CHF with atrial fibrillation in dogs with normal renal function
- Initial dosing for dogs weighing less than 20 kg
- Initial dosing for dogs weighing more than 20 kg
- Adjunctive treatment of dilated cardiomyopathy patients with atrial fibrillation
- Adjunctive treatment of atrial fibrillation
- Refractory heart failure or atrial fibrillation (if pimobendan unavailable)
- Supraventricular arrhythmias
- Management of supraventricular tachyarrhythmias
- Management of supraventricular tachyarrhythmias (Emergency/Rare)
How it is given
Possible side effects
- Cardiac arrhythmias (complete or incomplete heart block, bigeminy, ST segment changes, paroxysmal ventricular or atrial tachycardias, multifocal VPCs)
- Mild GI upset
- Anorexia
- Weight loss
- Diarrhea
- Vomiting (especially associated with IV injections)
- Vomiting
- Diarrhoea
- Depression
- Arrhythmias (AV block, bigeminy, paroxysmal ventricular or atrial tachycardias with block, multiform VPCs)
- Vasoconstriction (with IV administration)
Cautions & contraindications
- Ventricular fibrillation
- Digitalis intoxication
- Hypertrophic cardiomyopathy in cats (relative contraindication, may increase myocardial oxygen demand and dynamic outflow obstruction)
- Frequent ventricular arrhythmias
- Atrioventricular (AV) block
- Feline hypertrophic cardiomyopathy
- Hypokalaemia
- > **Extreme Caution:** Patients with glomerulonephritis and heart failure, or with idiopathic hypertrophic subaortic stenosis (IHSS). * **Caution:** Severe pulmonary disease, hypoxia, acute myocarditis, myxedema, acute myocardial infarction, frequent VPCs, V-tach, chronic constrictive pericarditis, or incomplete AV block. * **Renal Disease:** Principally eliminated by the kidneys; use with caution and monitor serum levels closely in patients with renal impairment. * **Electrolyte/Endocrine Imbalances:** Animals that are hypernatremic, hypokalemic, hypercalcemic, hyper- or hypothyroid may require smaller dosages; monitor carefully. * **Cardioversion:** Elective cardioversion of patients with atrial fibrillation should be postponed until digoxin has been withheld for 1-2 days. * **Dosing Weight:** Dosing is generally based upon **lean body weight** as digoxin does not distribute well into ascitic fluid or fat.
Drug interactions
- Aminosalicylic Acid: May reduce digoxin serum levels
- Antacids: May reduce digoxin serum levels
- Chloramphenicol: May reduce digoxin serum levels in dogs
- Cholestyramine: May reduce digoxin serum levels
- Cimetidine: May reduce digoxin serum levels
- Metoclopramide: May reduce digoxin serum levels
- Neomycin (Oral): May reduce digoxin serum levels
- Phenobarbital: May reduce digoxin serum levels
- St John's Wort: May reduce digoxin serum levels
- Sucralfate: May reduce digoxin serum levels
- Sulfasalazine: May reduce digoxin serum levels
- Amiodarone: May increase serum levels, decrease elimination rate, or enhance toxic effects
- Anticholinergics: May increase serum levels, decrease elimination rate, or enhance toxic effects
- Captopril (or other ACEIs): May increase serum levels, decrease elimination rate, or enhance toxic effects
- Coleus: May increase serum levels, decrease elimination rate, or enhance toxic effects
- Cyclosporine: May increase serum levels, decrease elimination rate, or enhance toxic effects
- Diazepam: May increase serum levels, decrease elimination rate, or enhance toxic effects
- Diltiazem: May increase serum levels (data conflicts); additive negative effects on AV conduction
- Erythromycin: May increase serum levels, decrease elimination rate, or enhance toxic effects
- Furosemide: May increase serum levels, decrease elimination rate, or enhance toxic effects; hypokalemia predisposes to digitalis toxicity
- Hawthorn: May increase serum levels, decrease elimination rate, or enhance toxic effects
- Ketoconazole/Itraconazole: May increase serum levels, decrease elimination rate, or enhance toxic effects
- Omeprazole (or other PPIs): May increase serum levels, decrease elimination rate, or enhance toxic effects
- Quinidine: May increase serum levels; rule of thumb is to decrease digoxin dose by 50% if used together
- Reserpine: May increase serum levels, decrease elimination rate, or enhance toxic effects
- Succinylcholine: May increase serum levels, decrease elimination rate, or enhance toxic effects
- Tetracycline: May increase serum levels, decrease elimination rate, or enhance toxic effects
- Verapamil: May increase serum levels; additive negative effects on AV conduction
- Beta-Blockers: Additive negative effects on AV conduction, complete heart block possible
- Penicillamine: May decrease serum levels of digoxin independent of route of digoxin dosing
- Potassium/Electrolyte altering drugs (e.g., amphotericin B, glucocorticoids, laxatives, insulin): May predispose the patient to digitalis toxicity via electrolyte imbalances (e.g., hypokalemia)
- Spironolactone: May enhance or decrease the toxic effects of digoxin
- Thyroid Supplements: Patients on digoxin that receive thyroid replacement therapy may need their digoxin dosage adjusted
- Chemotherapy agents (cyclophosphamide, cytarabine, doxorubicin, vincristine): May decrease digoxin absorption from the GI tract
- Antimuscarinics: May increase serum level, decrease elimination rate, or enhance toxic effects
- Loop and thiazide diuretics: Can cause hypokalaemia, which strongly predisposes to digoxin toxicity
- Oxytetracycline: May increase serum level, decrease elimination rate, or enhance toxic effects
- Cyclophosphamide: May decrease digoxin absorption from the GI tract
- Cytarabine: May decrease digoxin absorption from the GI tract
- Doxorubicin: May decrease digoxin absorption from the GI tract
- Vincristine: May decrease digoxin absorption from the GI tract
- Loop diuretics: May cause hypokalaemia, which enhances the toxic effects of digoxin
- Thiazide diuretics: May cause hypokalaemia, which enhances the toxic effects of digoxin
Česta pitanja
What is Digoxin used for in pets?
Digoxin is a potent heart medication used to help the heart pump more effectively and control irregular heartbeats. • Strict Dosing: Give this medication exactly as prescribed. Do not change the dose or stop the medication without consulting your veterinarian, as the difference between a helpful dose and a toxic dose is very small. • Watch for Toxicity: Contact your veterinarian immediately if your pet shows any signs of toxicity, which often start with gastrointestinal upset. Watch for loss of appetite, vomiting, diarrhea, lethargy, depression, or changes in behavior. • Missed Doses: If you miss a dose, do not double up on the next dose. Give the next dose at the regularly scheduled time. • Monitoring: Your pet will need regular blood tests to check the level of digoxin in their blood, as well as kidney function and electrolyte levels, to ensure the dose remains safe and effective.
Is Digoxin safe for my pet?
Dosage must be set by your veterinarian for your specific pet. Never give human medication or another pet’s prescription without veterinary guidance.
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