Digoxin dosing

Penicillamine Digoxin 1 Digoxin serum may be reduced, possibly decreasing its pharmacological effects. The digoxin dose may need to be increased. 

Quinidine can increase the plasma concentrations of digoxin, which may in turn lead to signs and symptoms of digitalis toxicity. Gastrointestinal, central nervous system (CNS), or cardiac toxicity associated with elevated digoxin concentrations may occur. Quinidine and digoxin can be administered concurrently however, a downward adjustment in the digoxin dose may be required. 

Digitalis glycosides augment contractile force and are likewise used in severe forms of insuf ciency, specifically in the presence of concomitant atrial fibrillation. Because of the narrow margin of safety, the digoxin dose must be adjusted individually in each patient. 

PROPAFENONE CARDIAC GLYCOSIDES Digoxin concentrations may be t by propafenone Uncertain at present Watch for digoxin toxicity check digoxin levels if indicated and 1 digoxin dose as necessary (15-75% suggested by studies)... 

Monitor digoxin levels, signs/symptoms of toxicity decrease digoxin dosing Decrease dose of quinidine by 30-50% Decrease dose of procainamide by 30% when starting amiodarone Monitor phenytoin levels and s/s of toxicity decrease phenytoin dosing if necessary Avoid NSAID use if possible in the elderly... 

Adjnstment of digoxin doses nsing steady-state concentrations is accomplished nsing linear pharmacokinetics and dosage ratios ... 

Digoxin does not improve survival in patients with heart failure but does provide symptomatic benefits, particularly in patients with moderate and severe heart failure and those with supraventricular tachyarrhythmias (e.g., atrial fibrillation). Digoxin doses should be adjusted to achieve plasma concentrations of 0.5 to 1 ng/mE higher plasma concentrations are not associated with additional benefits but may be associated with increased risk of toxicity. 

Quinidine increases digoxin levels decrease digoxin dose by 50%... 

Optimize heart failure therapy adjust digoxin dose appropriately... 

Correct thyroid disorder may require lower digoxin doses... 

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