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Digoxin Dosing Calculator

Determination of initial loading and maintanance dose.

Monitoring: Obtain blood samples at least 4 hrs after IV dose and 6-8hrs after an oral dose. Serum levels: 0.5 to 2.0 ng/ml. Obtain the first level within 24 hours of digitalization. Monitor BUN and serum creatinine q2days (qd if unstable). Monitor apical pulse daily. Onset/peak: IV: 5-30min/ 1-4hrs Oral: 1-2hrs/ 2-8 hrs. Time to steady state: 5-7 days (average) ESRD: 15-20 days. Half-life: 38-48 hrs. (anephric: 4-6 days).

Factors that increase the likelihood of digoxin toxicity: Hypokalemia, hypomagnesemia, hypothyroidism, renal dysfunction, interacting drugs (eg quinidine, verapamil).

Distribution: only a small fraction of digoxin in present in the blood (little is removed by hemodialysis). Digoxin distributes very little into body fat–doses must be based on lean body weight. Distribution is not altered by obesity. There appears to be a gradual contraction in the volume of distribution as renal function deteriorates. Therefore, extreme caution is necessary when dosing patients with renal failure.

Maximal response from any maintenance dose of digoxin will be obtained when serum concentrations are at steady state and maximal body stores for that dose have been obtained. It should be noted that any adjustment of dose or change in the elimination of digoxin requires a waiting period of 4-5 times the half-life (1 week with normal renal function) before the new steady state concentration is achieved.
If steady state levels are available, use this table instead. 
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Patient name:    Floor:
Age:     |            |        Scr(mg/dl): 
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Enter desired Cpeak:  Dosage form:    Acute CHF?
Interacting drugs:   

Dosing schedule:

References:

Aronson JK: Clinical pharmacokinetics of cardiac glycosides in patients with renal dysfunction. Clin Pharmacokinet 1983; 8:155-178.

Behr ER, Veysey MJ, Berry D, Volans GN.   Optimum dose of digoxin.    Lancet. 1997 Jun 21;349(9068):1845

Bennett WM, Aronoff GR, Golper TA et al: Drug Prescribing in Renal Failure. American College of Physicians, Philadelphia, PA, 1987.

Cauffield JS, Gums JG, Grauer K. The serum digoxin concentration: ten questions to ask. Am Fam Physician. 1997 Aug;56(2):495-503, 509-10

Cheng JW, Charland SL, Shaw LM, Kobrin S, Goldfarb S, Stanek EJ, Spinler SA.  Is the volume of distribution of digoxin reduced in patients with renal dysfunction? Determining digoxin pharmacokinetics by fluorescence polarization immunoassay. Pharmacotherapy. 1997 May-Jun;17(3):584-90.

Fenster PE, Hager WD & Goodman MM: Digoxin-quinidine-spironolactone interaction. Clin Pharmacol Ther 1984; 36:70-73.

Gilman AG, Rall TW, Nies AS et al (Eds): Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed. Macmillan Publishing Co, New York, NY, 1990.

Hammerlein A, Derendorf H, Lowenthal DT.   Pharmacokinetic and pharmacodynamic changes in the elderly. Clinical implications. Clin Pharmacokinet. 1998 Jul;35(1):49-64. 

Hui J, Wang YM, Chandrasekaran A, Geraets DR, Caldwell JH, Robertson LW, Reuning RH.  Disposition of tablet and capsule formulations of digoxin in the elderly.   Pharmacotherapy. 1994 Sep-Oct;14(5):607-12.

Jelliffe, 1968; Product information Lanoxin (R), Glaxo Wellcome Inc.  (Jelliffe RW: An improved method digoxin therapy. Ann Intern Med 1968; 69:703.)

Jusko WJ, Szefler SJ & Goldfarb AL: Pharmacokinetic design of digoxin dosage regimens in relation to renal function. J Clin Pharmacol, 1974; 14:525-535.

Koda-Kimble MA: Congestive heart failure, in Applied Therapeutics for Clinical Pharmacists, 2nd ed, edited by Koda-Kimble et al, Applied Therapeutics, Inc., San Francisco 1978; pp 161-86.

Kramer WG, Lewis RP, Cobb TC et al: Pharmacokinetics of digoxin: comparison of a two and a three compartment model in man. J Pharmacokinet Biopharm 1974; 2:299.

Lee CH, Park YJ, Sands CD, Jones DW, Trang JM.    Bioavailability of digoxin tablets in healthy volunteers.  Arch Pharm Res. 1994 Apr;17(2):80-6.

Mooradian AD: Digitalis: An update of clinical pharmacokinetics, therapeutic monitoring techniques and treatment recommendations. Clin Pharmacokinet 1988; 15:165-179.

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The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user’s use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. Read the disclaimer