Digoxin

Дигоксин Drug photo

The description is actual on 07.05.2015

  • Latin name: Digoxin
  • ATH code: C01AA05
  • Active ingredient: Digoxin
  • Producer: Gedeon Richter (Hungary), Binnofarm (Russia), Northern star (Russia), Updating (Russia), Grindex (Latvia),

Structure

1 tablet contains 0,25 mg of active ingredient digoxin.

1 ml of solution contains active agent in number of 0,25 mg.

Act as additional elements: glycerin, ethanol, sodium phosphate, acid lemon, injection water.

Form of production of Digoxin

Is issued in the form of solution for injections and in the tableted form.

Pharmacological action

Cardiac glycoside.

Pharmacodynamics and pharmacokinetics

Let's consider the mechanism of effect of the medicine.

Drug of a plant origin, digoxin receive from a woolly foxglove (Digitalis). Possesses the expressed cardiotonic action (a positive inotropic effect, increase of sokratitelny ability of a cardiac muscle due to increase of concentration of calcium ions in cardiomyocytes) thanks to what increases a stroke output of blood and minute volume. Reduces need of cells of a myocardium for oxygen.

Besides, has negative dromotropic and negative chronotropic effect, that is reduces the frequency of generation of an electric impulse a sinus node and the speed of carrying out an impulse on the atrioventricular carrying-out system of heart. Also has indirect effect on receptors of an aortic arch and increases activity of a vagus nerve that also slows down activity of a sinuatrial node.

Thanks to these mechanisms it is possible to reach decrease in frequency cordial reductions at supraventricular (supraventricular) tachyarrhythmias (paroxysmal or constant forms of atrial tachyarrhythmias, an atrial flutter).

At the expressed insufficiency of function of heart and signs of stagnation on big and small circles of blood circulation drug has indirect vazodilatatsionny effect that is shown in lowering of the general resistance of a peripheral vascular bed and reduction of degree of manifestation of an asthma and peripheral hypostases.

Is accepted inside, in a gastrointestinal tract 70% of active ingredient are soaked up, after reception extreme concentration is reached in the range from two till 6 o'clock. Parallel meal leads to some increase in time of absorption. The exception is made by the products rich with a cellulose — in this case the part of active ingredient is adsorbed by food fibers and becomes unavailable.

Has property to collect in liquids and fabrics including a myocardium that is used when determining the scheme of use: the effect of drug is calculated not on the maximum concentration of substance in plasma, and according to contents at the time of an equilibrium condition of pharmacokinetics.

50-70% drugs are brought by kidneys, heavy pathology of this body can promote accumulation of digoxin in an organism. The elimination half-life reaches two days.

Indications to Digoxin use

From what tablets and solution are usually applied?

Indications to use of Digoxin are disturbances of a cordial rhythm (arrhythmia) of supraventricular character (a paroxysmal ciliary tachyarrhythmia, an atrial flutter, a constant ciliary tachyarrhythmia).

The medicine is included in schemes of treatment of chronic insufficiency of heart of the third and fourth functional class, and also is applied at HSN of the second class if the expressed clinical manifestations are diagnosed.

Contraindications

Direct contraindications for prescription of medicine are symptoms of glikozidny intoxication, hypersensitivity to digoxin, Wolf-Parkinson-Vayta's syndrome, an atrioventricular block of the second degree and a total atrioventricular block, bradycardia.

It is impossible to appoint a medicine at such displays of coronary heart disease as unstable stenocardia and the acute period of a myocardial infarction.

Drug at the isolated mitral stenosis is contraindicated.

Heart failure of diastolic type (at a cardiac tamponade, at chronic cardial compression, at a heart amyloidosis, at a cardiomyopathy) is also contraindication to purpose of Digoxin.

The expressed dilatation of departments of heart, obesity, insufficiency of kidneys and hepatic parenchyma, myocardium inflammation, hypertrophy of an interventricular partition, subaortal stenosis, ventricular tachyarrhythmias — at these states use of medicine is inadmissible.

Side effects

First of all it is necessary to pay attention to possible side effects from cardiovascular system as they can be the first symptoms of the developing glikozidny intoxication.

Delay of atrioventricular conductivity and, as a result, delay of a rhythm belong to such symptoms (bradycardia), the emergence of the heterotropic centers of excitement of a myocardium which is shown in development of ventricular arrhythmias (ekstrasistoliya) and fibrillation of ventricles.

Extracardiac side effects do not represent, unlike endocardiac, threat of life of the patient. Signs of dysfunction of a digestive tract (nausea, pains in a stomach, vomiting and diarrhea), a nervous system concern to them (headaches, a depression or psychosis, disturbance of operation of the visual analyzer in the form of front sights before eyes, etc.).

From blood disturbance of a morphological picture in the form of thrombocytopenia can take place, and it will be shown by petechias on skin.

Possibly and development of allergic reactions to Digoxin in the form of an erythema of integuments, an itch and rash.

Application instruction of Digoxin (Way and dosage)

Inclusion of a medicine in schemes of treatment has to be made only in the conditions of a hospital. The therapeutic window of Digoxin (an interval between a medical dose and toxic) is not enough, and therefore, all recommendations about drug intake have to be observed strictly.

Tablets Digoxin, application instruction

At the first stage of treatment (a digitalization stage, or saturation of an organism of the patient drug) medicine is appointed in a dosage which it is accepted to call saturating: the patient accepts from two to four tablets (that makes 500 micrograms — one milligram) then pass to reception on one tablet with an interval of 6 hours. So proceeds before receiving therapeutic effect, and stable concentration of digoxin in blood is reached within seven days.

At the following stage pass to regular reception of a maintenance dose of drug which usually makes half-tablets or one tablet in days (one tablet of Digoxin contains 250 micrograms of active ingredient). It is impossible to pass drug intake, as well as it is impossible to accept in one step the doubled dose at the admission of reception of medicine. It is fraught with development of intoxication that can end with a lethal outcome.

In cardiological departments and in department of cardioreanimation the medicine is appointed and intravenously for the purpose of stopping of supraventricular paroxysmal tachyarrhythmias.

Overdose

Overdose symptoms (glikozidny intoxication): heart rate is slowed down, the sinus bradycardia appears. On the electrocardiogram signs of delay of atrioventricular conductivity, up to a total atrioventricular block appear. Heterotropic sources of a rhythm give ventricular extrasystoles, fibrillation of ventricles is possible. Extracardiac symptoms of intoxication glycosides are shown by dyspepsia (nausea, diarrhea, anorexia), decrease in memory and cognitive functions, drowsiness, head pains, weakness in muscles, erectile dysfunction, a gynecomastia, psychosis, concern, euphoria, a xanthopsia, decrease in visual acuity and other disturbances in operation of the visual analyzer.

In case of symptoms of intoxication glycosides tactics depends on expressiveness of manifestations: it is enough to lower the Digoxin dose at insignificant manifestations of overdose. If progressing of side effects takes place, it is worth taking a small break which duration depends on dynamics of symptoms of intoxication. Acute poisoning with Digoxin demands a gastric lavage, reception of sorbents in large numbers. The patient is given laxative.

Ventricular arrhythmias can be eliminated with intravenous administration of potassium chloride with insulin addition. Categorically it is impossible to appoint potassium drugs at delay of atrioventricular conductivity. At preservation of arrhythmia enter intravenously Phenytoinum. For treatment of bradycardia atropine is used. In parallel appoint the oxygenotherapy and drugs increasing the volume of the circulating blood. An antidote of Digoxin is Unithiolum.

It is important to remember that it is possible at overdose a lethal outcome.

Interaction

Medicine cannot be combined with alkalis, with acids, with salts of heavy metals and with tannins. When using together with diuretics, insulin, drugs of salts of calcium, sympathomimetics, glucocorticosteroids the risk of emergence of symptoms of glikozidny intoxication increases.

In a combination with quinidine, Amiodaronum and erythromycin increase in content of digoxin in blood is noted. Quinidine slows down removal of active agent. The blocker of calcium channels Verapamil reduces rates of elimination of digoxin from an organism kidneys that leads to increase of concentration of cardiac glycoside. This effect of verapamil is gradually leveled at long joint administration of drugs (more than six weeks).

The combination with Amphotericinum In increases probability of development of overdose by glycosides owing to a hypopotassemia which is provoked by V. Giperkaltsiyemiya's Amphotericinum increases a susceptibility of cardiomyocytes to cardiac glycosides, and therefore it is not necessary to resort to intravenous administration of drugs of calcium to patients who accept cardiac glycosides. The concomitant use of Digoxin in a combination with Reserpinum, propranolol, Phenytoinum increases probability of development of ventricular arrhythmias.

Phenylbutazone and drugs of group of barbiturates reduce concentration and efficiency of a medicine. Also the potassium drugs, drugs lowering acidity of a gastric juice, Metoclopramidum reduce medical effect. At a combination to antibiotics at erythromycin and gentamycin the maintenance of a glycoside grows in the patient's plasma. The concomitant use of a medicine with holestipoly, holestiraminy and magnesian laxatives leads to deterioration in absorption of drug in intestines owing to what decrease in amount of digoxin in an organism takes place also. The metabolism of glycosides accelerates at the combined reception with rifampicin and Sulfasalazinum.

Terms of sale

The recipe is required.

Storage conditions

In the place, unavailable to children, at a temperature of 15-30 degrees Celsius.

Period of validity

No more than three years.

Special instructions

In pediatric practice the tableted form is not used.

The recipe of Digoxin on Latin:

Rp. Digoxini 0,00025
    D. t. d. N 30 in tabul.
    S. On 1 tab. once a day in 30 minutes prior to food.

MNN according to the reference book Vidal: Digoxin.

At pregnancy and a lactation

Influence of medicine on a fruit in clinical trials was not studied, but drug is capable to break a gematoplatsentarny barrier and to get to a fruit organism. Digoxin at pregnancy is appointed only according to the emergency indications.

If the nursing mother takes this medicine, at the child it is necessary to control heart rate constantly.

Zdravzona

  • No. 30 digoxin 0,25mg tabletkifarmstandart-Tomskhimfarm joint stock company
  • No. 50 digoxin 0,25mg tabletkigrindeks joint-stock company
  • Tablet No. 30 digoxin 0,25mg mkhfp
  • Digoxin of 0,025% 1 ml No. 10 of amp. mkhfpmoskhimfarmpreparata to them N. A. Semashko of joint stock company
  • No. 50 digoxin 0,25mg tablet/Gideon rikhter/Gedeon Richter

Drugstore of IFC

  • Digoxin tbl 250 mkg No. 50 **, Gedeon Richter-RUS Zaorossiya
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Apteka24

  • Digoksinoz GNTSLS (Ukraine, Kharkiv)
  • Digoksinborshchagovsky HFZ (Ukraine, Kiev)
  • Digoksinoz GNTSLS (Ukraine, Kharkiv)
  • Digoksinzdorovye (Ukraine, Kharkiv)

Paniapteka

  • Digoxin solution for infection. 0.025 amp %. 1 ml No. 10OZ GNTsLS
  • Digoxin solution for infection. 0.025 amp %. 1 ml No. 10OZ GNTsLS
  • Digoxin solution for infection. 0.025 amp %. 1 ml No. 10OZ GNTsLS
  • Digoxin solution for infection. 0.025 amp %. 1 ml No. 10OZ GNTsLS

BIOSPHERE

  • Digoxin of 0,25 mg No. 50 of table.
  • Digoxin of 0,25 mg No. 40 of the tab. Borshchagovsky himfarmzavod (Ukraine)
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Section: Cardiovascular
in more detail

Education: Graduated from the Bashkir state medical university majoring in "Medical business". In 2011 gained the diploma and the certificate in Therapy. In 2012 received 2 certificate and the diploma in "Functional diagnosis" and "Cardiology". In 2013 completed courses on "Topical issues of otorhinolaryngology in therapy". In 2014 completed advanced training courses in "A clinical echocardiography" and courses in "Medical rehabilitation".

Experience: From 2011 to 2014 the Policlinic No. 33 Ufa worked as the therapist and the cardiologist in MBUZ. Since 2014 the Policlinic No. 33 Ufa works as the cardiologist and the doctor of functional diagnosis in MBUZ.

PAY ATTENTION! Information on drugs on the website is help generalizing, collected from public sources and can form the basis for making decision on use of medicines it is not aware of treatment. Before medicine use Digoxin surely consult with the attending physician.