Digoxin should be used with caution in:
- patients who have had a recent heart attack (myocardial infarction) or congestive heart failure,
- low potassium or magnesium levels in your blood (hypokalaemia or hypomagnesaemia),
- high calcium levels in your blood (hypercalcaemia),
- heart problems caused by a lack of vitamin B, known as ‘Beri-Beri disease’,
- kidney problems,
- lung problems,
- thyroid problems,
- digestion problems,
- abnormal heart rhythms,
- sick sinus syndrome,
- hypoxia (risk of digitalis toxicity),
- The elderly
It should not be used in:
- second degree or intermittent complete heart block,
- certain types of supraventricular arrhythmias,
- ventricular tachycardia or ventricular fibrillation,
- hypertrophic obstructive cardiomyopathy,
- patients with allergies to digoxin, digitoxin or any other ingredients.
Also see list of precautions and interactions
Store below 25°C in a dry place.
Digoxin is used to slow down the rate of the heart, but increase the force with which the heart muscle contracts.
It is a cardiac glycoside.
It is used to make the heart work efficiently.
In general this drug is used to treat heart failure and irregular heart beats or irregular heart rhythm (including atrial flutter or fibrillation).
Benefits of being on this drug can include reduction of ventricular rate.
Listed below are the typical uses of digoxin.
- Chronic cardiac failure (heart failure),
- Cardiac failure accompanied with atrial fibrillation,
- Atrial fibrillation and flutter,
- Where emergency digitalisation (treatment with digoxin) is required in patients who have not been given similar medicines (cardiac glycosides) within the preceding two weeks.
On occasion your doctor may prescribe this medicine to treat a condition not on the above list.
HOW TO USE/TAKE
How often do I take it?
- Take this medication orally usually once a day, with water. Digoxin can be taken with most foods. However, you should avoid taking it with foods that are high in fibre (e.g. brown bread, cereals, fruit, vegetables and pulses), as the amount of digoxin absorbed into the body may be reduced.The first time you take Digoxin tablets, your doctor will ask you to take a certain number of tablets as a single dose, this is called the initial dose. They will monitor your response which may involve a blood test. Your regular dose may change depending on how you respond to the medication. Digoxin injection is for administration by slow intravenous infusion
- Use this medication regularly, as instructed by your doctor, in order to get the most benefit from it.
- Remember to use it at the same time each day - unless specifically told otherwise by your doctor.
- It may take a number of days before the full benefit of this drug takes effect.
- Certain medical conditions may require different dosage instructions as directed by your doctor.
- Dosage is based on your age, gender, medical condition, response to therapy, and use of certain interacting medicines.
Do I need to avoid anything?
- Patients should exercise caution before driving, using machinery or participating in dangerous activities. Consult your doctor or pharmacist for more details.
When can I stop?
- It is important to continue taking this medication even if you feel well, unless your doctor tells you to stop.
DIGOXIN SIDE EFFECTS
- chest pain,
- shortness of breath,
- slow or irregular heart beat,
- nausea, vomiting or diarrhoea,
- rash that may be itchy,
- drowsiness or dizziness,
- visual disturbances, with blurred or yellow-green sight,
- Details of other side effects can be found in the patient information leaflet.
Children are especially sensitive to the effects of digoxin .
Side-effects may include loss of appetite, feeling or being sick and diarrhoea. Irregular or fast heartbeats have been reported.
If any of these persist or you consider them severe then inform your doctor.
Tell your doctor immediately if you develop any of the following symptoms:
Palpitations, chest pain, shortness of breath, sweating.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
The Yellow Card Scheme allows you to report suspected side effects from any type of medicine (which includes vaccines, herbals and over the counter medicines) that you are taking. It is run by the medicines safety watchdog called the Medicines and Healthcare products Regulatory agency (MHRA). Please report any suspected side effect on the Yellow Card Scheme website.
Before taking digoxin, tell your doctor or pharmacist if you are allergic to it; or to other cardiac glycosides; or if you have any other allergies.
This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: second degree or intermittent complete heart block, supraventricular arrhythmias, ventricular tachycardia or ventricular fibrillation, hypertrophic obstructive cardiomyopathy, patients with allergies to digoxin, digitoxin or any other ingredients.
Before using this medication, tell your doctor or pharmacist your medical history, especially any of the following: recent heart attack (myocardial infarction) or congestive heart failure, low potassium or magnesium levels in your blood (hypokalaemia or hypomagnesaemia), high calcium levels in your blood (hypercalcaemia), heart problems caused by a lack of vitamin B, known as ‘Beri-Beri disease’, kidney problems, lung problems, thyroid problems, digestion problems, abnormal heart rhythms, sick sinus syndrome, hypoxia (risk of digitalis toxicity), pregnancy.
Before having surgery, tell your doctor or dentist that you are taking this medication.
Alcohol intake is not known to affect digoxin.
The elderly: the dose of dioxin should be reduced in the elderly as it may result in toxicity.
Pregnancy and breastfeeding - please ensure you read the detailed information below
The safety of digoxin has not been established during pregnancy. Ask your doctor or pharmacist if you have any doubts or questions about this.
It is sensible to limit use of medication during pregnancy whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
You should speak to your doctor before taking digoxin if you are breastfeeding as small quantities can pass into breast milk.
It is sensible to limit use of medication during breastfeeding whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
Before using this medicine, tell your prescriber of all the medicines you are taking including prescription medicines and medicines you have bought over the counter without a prescription. Tell your prescriber if you are taking vitamins or complementary remedies such as herbal products, as these can also interact with medicines.
If you are taking more than one medicine, these may interact with each other. Your prescriber may decide to use medicines which interact with each other if the benefit outweighs the risks. In these cases, the dose of your medicines may need to be adjusted or you may be monitored more closely.
The following medicines may interact with digoxin:
- St Johns Wort (Hypericum perforatum)
- Telmisartan, prazosin, captopril, nifedipine, nisoldipine, verapamil, diltiazem, nitroprusside, hydralazine, acetazolamide, furosemide, triamterene, spironolactone, or amiloride (used to treat high blood pressure)
- Sulfasalazine, penicillamine, chloroquine or hydroxychloroquine (used to treat rheumatoid arthritis)
- Atorvastatin, colestipol or colestyramine (used to lower cholesterol)
- Kaolin (used to treat stomach upsets) and antacids (used for indigestion)
- Amiodarone, disopyramide, flecainide, moracizine, propafenone, or quinidine (used to treat irregular heart rhythms), beta blockers (e.g. propranolol or atenolol used to treat various heart conditions)
- Tetracycline, azithromycin, clarithromycin, erythromycin, telithromycin, neomycin, rifampicin, trimethoprim (used to treat infections caused by bacteria)
- Amphotericin, itraconazole (used to treat infections caused by fungi)
- Nefazodone, trazodone or lithium (used to treat depression) and alprazolam or diazepam (used to treat anxiety)
- Acarbose (used to treat diabetes)
- Phenytoin, topiramate (used to treat epilepsy)
- Quinine (used to treat malaria and night-time leg cramps)
- Calcium salts (e.g. calcium gluconate or calcium lactate) and vitamin D
- Carbimazole (used to treat hyperthyroidism)
- Ciclosporin (used following organ transplants)
- Corticosteroids (e.g. prednisolone, hydrocortisone)
- Medicines used to treat cancer
- Edrophonium, suxamethonium, pancuronium, or tizanidine (muscle relaxants);
- aspirin, azapropazone, diclofenac, fenbufen, ibuprofen, indometacin, tiaprofenic acid, or phenylbutazone (medicines known as Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and used to treat pain)
- Salbutamol (used to treat asthma)
- Carbenoxolone, omeprazole, pantoprazole, rabeprazole, or sucralfate (used to treat stomach ulcers)
- Medicines for preventing organ transplant rejection
- Medicines for problems with your immune system
- Medicines for preventing blood clots during kidney dialysis water tablets (diuretics)
This information does not contain all possible interactions. Therefore, tell your prescriber of all the products you are using before taking this medicine.
If you have a question or want to discuss anything about your medicine, speak to your local pharmacist.
If you think you, or someone you care for, might have accidentally taken more than the recommended dose of digoxin or intentional overdose is suspected, contact your local hospital, GP or if in England call 111. In Scotland call NHS 24. In Wales, call NHS Direct Wales. In the case of medical emergencies, always dial 999.
If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.