Digoxin is contraindicated in patients with a known hypersensitivity to digoxin or other forms of digitalis. If there is a suspicion that digitalis toxicity exists, elective cardioversion should be delayed. The recommended approach is to:Dose titration may be accomplished by either of two general approaches that differ in dosage and frequency of administration, but reach the same total amount of digoxin accumulated in the body.In general, the dose of digoxin used should be determined on clinical grounds. A steady state will be achieved after five cycles of the drug half-life (T1/2ß), which is approximately 7 to 10 days in the average subject. The block on the chart at which the two rows (weight and target dose) intersect is the milliliter amount that should be given to the patient.The monitoring described in Section 2.2 may suggest increases or decreases in digoxin doses. Provided is the volume required per dose, NOT per day.On the left side of the chart, locate the patient’s weight in kilograms. The inotropic effects of digoxin tend to appear at lower concentrations than the electrophysiological effects. The measured levels of DLIS (as digoxin equivalents) are usually low (0.2 to 0.4 ng/mL), but sometimes they reach levels that would be considered therapeutic or even toxic.In some assays, spironolactone, canrenone and potassium canrenoate may be falsely detected as digoxin, at levels up to 0.5 ng/mL. Randomization to digoxin was again associated with a significant reduction in the incidence of hospitalization, whether scored as number of hospitalizations for heart failure (relative risk 75%), risk of having at least one such hospitalization during the trial (RR 72%), or number of hospitalizations for any cause (RR 94%). Digoxin reduced the resting heart rate, but not the heart rate during exercise.In 3 different randomized, double-blind trials that included a total of 315 adult patients, digoxin was compared to placebo for the conversion of recent-onset atrial fibrillation to sinus rhythm. In addition to cardiac monitoring, digoxin should be temporarily discontinued until the adverse reaction resolves. Doses should be titrated to the lowest dose needed to achieve effect. Other reported manifestations of overdose are weight loss in older age groups, failure to thrive in infants, abdominal pain caused by mesenteric artery ischemia, drowsiness, and behavioral disturbances including psychotic episodes. The use of digoxin has been associated with abdominal pain, intestinal ischemia, and hemorrhagic necrosis of the intestines.Digoxin can produce visual disturbances (blurred vision, green-yellow color disturbances, halo effect), headache, weakness, dizziness, apathy, confusion, and mental disturbances (such as anxiety, depression, delirium, and hallucination).Gynecomastia has been reported following the prolonged use of digoxin. Therefore, this amount should have no pharmacologic effect upon the infant. Reduce digoxin dose by approximately 15% to 30% or by modifying the dosing frequency and continue monitoring.Alprazolam, Azithromycin, Cyclosporine, Diclofenac, Diphenoxylate, Epoprostenol, Esomeprazole, Ibuprofen, Ketoconazole, Lansoprazole, Metformin, Omeprazoleinitiating concomitant drugs. Prescribers should consult the prescribing information of any drug which is co-prescribed with digoxin for potential drug interaction information.Digoxin is a substrate for P-glycoprotein, at the level of intestinal absorption, renal tubular section and biliary-intestinal secretion. Therefore, drugs that induce/inhibit P-glycoprotein have the potential to alter digoxin pharmacokinetics.Measure serum digoxin concentrations before initiating concomitant drugs. Renal excretion of digoxin is proportional to glomerular filtration rate.The serum half-life of digoxin in pediatric patients is reported to be 18 to 36 hours, and in adults it is typically 36 to 48 hours. Pediatric patients are more likely to develop A-V conduction disturbances, or sinus bradycardia. Treatment of these patients with digoxin leads to greater slowing of conduction in the atrioventricular node than in accessory pathways, and the risks of rapid ventricular response leading to ventricular fibrillation are thereby increased.Because digoxin slows sinoatrial and AV conduction, the drug commonly prolongs the PR interval. Starting at 0.1 mL, this 1 mL oral syringe is marked in divisions of 0.1 mL, corresponding to 5 mcg or 0.005 mg of digoxin.Allergy to digoxin is rare. Reduce digoxin dose by approximately 30% to 50% or by modifyingMeasure serum digoxin concentrations before initiating concomitant drugs. This is followed by a much more gradual decline in the serum concentration of the drug, which is dependent on the elimination of digoxin from the body. The range of percentages provided in Table 2 (2.4 Estimate of Daily Maintenance Dose) can be used in calculating this dose for patients with normal renal function. A dose above 25 mg ingested by an adult without heart disease appeared to be uniformly fatal if no Digoxin Immune Fab (DIGIBINDIn pediatric patients, signs and symptoms of toxicity can occur during or shortly after the dose of digoxin.