Digoxinequal drug 3-2 treatment of congestive heart failure, vibration (1 blister x 30 tablets)
Dosage form Box of 1 blister x 30 tablets
Specifications Digoxin
Ingredient Esophageal ulcer, heart failure
Ingredient
| Composition information | Content |
| Digoxin | 0.25mg |
Uses
indicated
Digoxine Que is indicated in case of:
The main effect of digoxin is to inhibit Adenosine Triphosphatase and therefore sodium -potassium exchange (Na+ - K+), the change of ion distribution through the membrane creates an enhanced calcium ion, increasing the availableness of calcium at the time of stimulation of CO. Therefore, the effect of Digoxin can increase significantly when extracellular potassium concentration, when hyperkalemia will have the opposite effect.
Digoxin inhibits the Na+ - K+ Exchange mechanism on the cells of the autonomic nervous system, stimulating them indirectly on the heart activity. The increase in sympathetic impulses reduces sympathetic tone and reduces the pulse speed reduction through the atria and the atrial node.
Pharmacokinetics
absorption
TMAX is used for 2-6 hours. When taken, Digoxin is absorbed from the stomach and upper part of the small intestine. When Digoxin is taken after a meal, the absorption speed is slowed down, but the total amount of Digoxin is absorbed often does not change. However, when drinking with high fiber meals, oral absorption is reduced. Digoxin's bioavailability is about 63% in the form of tablets.
Distribution
The initial distribution of digoxin from the center to the peripheral usually lasts from 6 to 8 hours. Next is to gradually reduce the concentration of Digoxin in serum, depending on the elimination of digoxin from the body. Very large distribution (VDSS = 510 liters in healthy volunteers), showing that Digoxin has a large bond with body tissues.
The highest Digoxin concentration is seen in the heart, liver and kidney, in the heart an average 30 times higher than the whole week of the body. Although the skeletal muscle concentration is much lower, skeletal muscles account for 40% of the total body weight. In small percentage of plasma circulation, about 25% linked to protein.
Metabolism
Most of the digoxin is excreted through the kidneys in a constant form, although a small part of the dose is converted into active and non -activity metabolites. The main metabolites of digoxin are dihydrodigoxin and digoxygenin.
Elimination
The main excretion line is excreted through the renal in the form of constant.
Before taking Digoxinequal drug 3-2 treatment of congestive heart failure, vibration (1 blister x 30 tablets)
How to use
oral medication.
DosageThe proposed dose is only for the original instructions, each patient must be adjusted separately according to age, weight and kidney function.
In the case of a patient who used the heart glycosides two weeks earlier, review the initial dose of the patient and should reduce the dose.
Pay attention to the difference of bioavailability between injection digoxin and oral digoxin when switching from this line to the other. For example, if the patient is transferred from oral to intravenously, the dose of digoxin must be reduced by about 33%.
adults and children over 10 years old
Quick starting dose:
Using the dose of 0.75 mg - 1.5 mg, a single dose. If there is a higher risk or less urgent, oral starting dose should be divided every 6 hours apart, clinical response assessment before additional dose.
Slow starting dose:
dose 0.25 - 0.75 mg/day for 1 week, then use the appropriate maintenance dose.
Patients should have clinical response within a week.
The choice between fast or slow therapy depends on the clinical condition of the patient and the emergency level of this condition.
Maintenance dose:
The maintenance dose should be based on the percentage of the daily decrease in each patient through excretion. The following calculation formula has been widely used in clinical: maintenance dose = starting dose x [(14 + Creatinin clearance (CCR)/5)]/100.
CCR is creatinine clearance in 70 kg of weight or 1.73 m2 of body surface area. If the serum creatinine level (SCR) is only available, the CCR ratio (70 kg of weight) can be estimated in men according to the following formula: CCR = [(140 - Age)/SCR (mg/100 ml)].
When the serum creatinine value is calculated according to micromol/l, it can be switched to Mg/100 ml (mg/%) according to the following formula: SCR (mg/100 ml) = [SCR (micromol/l) x 113.12]/10000 = SC (micromol/l)/88.4.
where 113,12 is the molecular weight of creatinin.
For women, this result will be multiplied by 0.85.
Cannot use these formulas for creatinine clearance in children.
In fact, most patients with heart failure are maintained daily dose of digoxin from 0.125 - 0.25 mg; However, in people who are highly sensitive to the side effects of digoxin, dose 0.0625 mg daily or less. In contrast, some patients may need higher doses.
Children under 10 years old
In newborns, especially in premature babies, the renal clearance of digoxin decreases and the appropriate dose reduction must be followed on the general dose guide.
In addition to the newborn period, children often need higher dose rates than adults based on weight or body surface area. Children over 10 years of age use adults in proportion to their children's weight.
Starting dose:
Infants lack a month less than 1.5 kg: 25 mcg/kg/24h.
Babies lack monthly 1.5 kg - 2.5 kg: 30 mcg/kg/24h.
Babies are full to 2 years old: 45 mcg/kg/24h.
Children from 2 to 5 years old: 35 mcg/kg/24h.
Children from 5 to 10 years old: 25 mcg/kg/24h.
Should divide the starting dose into several times with about half of the total dose given at the first dose. And the remaining dose in the total dose given about 4 to 8 hours, clinical response evaluation before each additional dose.
Maintenance dose:
Infants lack monthly: Daily dose = 20% of the starting dose in 24 hours.
Babies are full monthly and children under 10 years of age: Daily dose = 25% of the starting dose in 24 hours.
Guidelines for dose schedules, clinical status monitoring and serum Digoxin levels should be used as a basis for adjusting the dose in these groups of children. If the cardiac glycoside is given in two weeks before starting digoxin treatment, the optimal digoxin dose may be less than the recommended doses.
With Digoxin doses used for children, should use appropriate dosage form (e.g. oral solution) to divide the dose correctly.
Elderly
Impaired renal and low -weight impairment in the elderly affects the pharmacokinetics of digoxin, so the high serum and related digoxin concentration can occur quite easily. Need to check the dioxin concentration in serum regularly and should avoid hypokalemia.
kidney failure
Should reduce the starting dose and maintenance dose in patients with impaired renal function because the main elimination of digoxin is excreted through the kidneys in a constant form.
thyroid disease
Be careful when using digoxin for patients with thyroid disease. The starting dose and maintenance dose of digoxin should be reduced when abnormal thyroid function. In hyperthyroidism, there is relative digoxin resistance, so it may have to increase the dose. During the treatment of armor poisoning, Digoxin should be reduced until the poisoning is controlled.
Gastrointestinal tract disease
Patients with malabsorption or regeneration of the digestive system may need larger digoxin dose.
Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.What to do when overdose?
symptoms and signs
Symptoms and signs of poisoning are often similar to the symptoms described in the side effects, but may occur frequently and may be worse.
Digoxin poisoning signs and symptoms occur more often with concentrations of over 2.0 ng/ml (2.56 nmol/l) despite a significant change between different patients. However, in the conclusion whether the patient's symptoms are due to digoxin or not, the clinical condition, the electrolyte concentration in the serum and the thyroid function are important factors, in patients with hemorrhage, using digoxin is associated with increased mortality rate; Patients with low potassium levels are at highest risk.
Adults
In adults without heart disease, clinical observation shows that the overdose of digoxin from 10 to 15 mg is a death dose for half of the patients. If the dose of digoxin is more than 25 mg for adults without heart disease, death or toxicity, it only responds to FAB antibodies.
Heart manifestations
Heart manifestations are the most common and serious signs when acute and chronic poisoning. The peak on the heart is usually 3 to 6 hours after overdose and may last for 24 hours later or longer. The toxicity of digoxin can lead to any kind of arrhythmia. Often encounter many arrhythmia in the same patient. Including dramatic tachycardia with transformer atrial block (AV), increasing the rhythm of the connection, slow atrial fibrillation (with very little ventricular rhythm) and two -way ventricular tachycardia.
Early ventricular contractions (PVC) are usually the earliest and most common arrhythmia. Double or three spans also occur often.
Sinus pace and other bradycardia are very common.
heart block level 1,2,3 and atrial fertilizer is also common.
Early toxicity can only be manifested by extending the PR range.
ventricular tachycardia can also be a manifestation of toxicity.
Cardiac arrest due to heartlessness or ventricular vibration due to poisoning Digoxin is often fatal.
Extremely overdose of acute digoxin can lead to mild hyperpassia due to inhibition of sodium - potassium pump (Na+ - K+). Hypotension can contribute to toxicity.
Symptoms are not in the heart
The gastrointestinal symptoms are very common in both acute and chronic poisoning. Symptoms before the heart manifestation is about half of the patients in most reports. Anorexia, nausea and vomiting have been reported at up to 80%. These symptoms often appear early when overdose.
Mental and visual manifestations occur in both acute and chronic poisoning. Dizziness, central neurological disorders, fatigue and discomfort are very common. The most frequent visual disorder is the color of color (the dominant green yellow). These neurological and visual symptoms may exist even if other toxic signs have been resolved.
In chronic poisoning, nonspecific symptoms are not in the heart, for example, uncomfortable and weak, can dominate.
Children
Children from 1 to 3 years old without heart disease, clinical observation shows that the overdose of digoxin from 6 to 10 mg is the dose leading to death at 1/2 of patients.
If children from 1 to 3 years old do not have heart disease to take more than 10 mg of digoxin, the entire patient will die when not treated with Fab segment.
Most of the manifestations of chronic poisoning in children occur in or immediately after the overdose of digoxin.
Heart manifestations
Similar arrhythmia or combined arrhythmia occurs in adults can also occur in children. Sinus tachycardia, ventricular tachycardia, and faster atrial fibrillation are less common in children.
Pediatric patients are more likely to have a variable atrial transmission (AV) or sinus rhythmic disorder. The ventricles are less common, but when the overdose is large, the ventricular ventricular, ventricular tachycardia and ventricular vibration have been reported.
In newborns, sinus or sinus slowdowns and/or prolonged PR interval are frequent signs of poisoning. Sinus pace is common in infants and young children. In older children, the transformed atrial block is the most common conduction disorders.
Any arrhythmia or changes in cardiac transmission in children using digoxin should be assumed by digoxin, until there are additional reviews.
Symptoms are not in the heart
The common manifestations are not in the heart similar to adults, gastrointestinal tract, central nervous and visual. However, rarely nausea and vomiting in infants and young children.
In addition to unwanted effects in the recommended dose, weight loss in the group of elderly and underdeveloped patients in children, abdominal pain due to ischemia, drowsiness and behavioral disorders including mental signs that have been reported when overdose.
Treatment
After an overdose, random or intentional, initially reduces the absorption by gastric lavage. The gastric lavage increases the vagina tone and can promote or worsen the arrhythmia. Consider when treating with Atropine first if you have a stomach. Digitalis Fab antibodies often show that it is not necessary to get gastric lavage. In rare cases when gastric lavage is indicated, it should only be done by appropriate professional training staff.
Patients with large amounts of digitalis should take a larger dosage to prevent the absorption and connection of digoxin in the intestine during the re -circulatory process.
If there is a phenomenon of hypokalemia, oral supplementation is needed by oral or intravenously, depending on the emergency level of this condition. In case of drinking large amounts of digoxin, hyperkalemia may be increased due to potassium release from skeletal muscles. Before using potassium during the overdose of digoxin, must know in advance serum levels.
Slow heart rate can respond to atropine but may need temporary heart rate. The ventricular arrhythmia can respond to lignoCaine or phenytoin.
Hemorrhage is not particularly effective in removing digoxin from the body when poisoning is life -threatening.
Digoxin Fab's specific antibody is a specific treatment when Digoxin poisoning and very effective. Quickly reverse complications related to severe digoxin, digitoxin and related glycosides when using specific antibodies (from sheep) resistant to Digoxin (FAB) intravenously.
What to do when you forget a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Note that it should not be used double the prescribed dose.
Side Effects
When using Digoxine Qimin, you may experience unwanted effects (ADR).
Common, ADR> 1/100
Skin and subcutaneous tissue: The skin rash of urticaria or pink pink may be accompanied by obvious eosine white blood cells.
Uncommon, 1/1000 Rare ADR Reproduction: Big breast condition in men can occur when long -term use. Not determined frequency Mental system: disorientation, memory loss, delirium, visual illusion and hearing. Children Instructions on how to handle ADR When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.
Warnings
contraindicated
Digoxin qualybut contraindicated in the following cases:
Patients with ventricular arrhythmia due to atrial pathway, as in Wolff - Parkinson - White (WPW) syndrome, unless the physiological properties of the auxiliary path and any harmful effects of digoxin for these properties have been evaluated. If there is or suspected there is auxiliary path and no history of arrhythmia on the previous ventricular, contraindicated use of digoxin.
Be cautious when using
monitoring
Patients using digoxin should be periodically evaluated with serum and kidney function (serum creatinine concentration); The frequency of evaluation will depend on clinical status.
Serum digoxin concentration can be indicated by the usual unit of NG/ml or the SI unit is nmol/l. To convert/ml to nmol/l, multiply/ml with 1.28.
Digoxin's serum concentration can be determined by radioactive immunity.
Should take blood for 6 hours or more after the last dose of digoxin.
Digoxin's toxicity is usually due to serum disco concentration greater than 2 ng/ml. However, the concentration of Digoxin in serum should be shown on clinical conditions. Poisoning can occur at lower serum digoxin concentrations. When concluding whether the patient's symptoms are due to digoxin or not, the patient's clinical condition, along with serum potassium and thyroid function, are important factors.
Determining serum Digoxin levels can be very helpful in making the next treatment decision with digoxin, but other glycosides and substances like endogenous Digoxin, including metabolites of digoxin, can interfere with existing tests and always be alert to the values that are not commensurate with the patient's clinical condition. Short -term observations with digoxin may be more appropriate.
arrhythmia
Cardiac arrhythmia can occur by digoxin toxicity, some cases may be like the arrhythmia that the drug may be recommended (for example, tachycardia with other atrial blocks should be paid special attention due to clinical beating like atrial fibrillation).
Many beneficial effects of digoxin in the arrhythmia due to the level of the atrial closing atrium. However, when the atrial block is not completely occurred, it is advisable to predict the impact of rapid progression. In the completely heart block block, the heart rate may be inhibited.
Sinus node disorders
In some cases of sinus node disorders, Digoxin may cause or worsen the sinus slow or sinus pace.
Do not combat the use of digoxin in the stage right after myocardial infarction. However, the use of medications increases muscle contraction in some patients in this case may increase the need for myocardial oxygen and ischemia, and some research monitoring studies have shown that digoxin is associated with increased risk of death. The possibility of arrhythmia arising in patients who may lower blood potassium after myocardial infarction and cannot stabilize hemodynamics must be noted.
Amyloid heart disease
avoid treatment with digoxin in patients with amyloid cardiomyopathy. However, if the inappropriate replacement treatment method, Digoxin can be used to control ventricular speed in patients with amyloid and atrial heart disease.
Myocarditis
Digoxin rarely causes vasoconstriction, should be avoided in patients with myocarditis.
Beri - Beri heart disease
Patients with Beri - Beri heart disease may not respond well with Digoxin if not treated at the same time.
Contracting pericarditis
Do not use Digoxin in pericarditis unless used to control ventricular rhythms in atrial fibrillation or to improve systolic dysfunction.
exertion
Digoxin improves exertion in patients with normal ventricular dysfunction and normal sinus rhythms. This may or may not be related to hemodynamic improvement. However, the benefits of Digoxin in patients with the most obvious ventricular arrhythmia when resting, less obvious when exercising.
Stop drugs
In patients taking diuretics or diuretics in combination with ACE inhibitors, Digoxin stops showing a decrease in clinical results.
ECG
The use of Digoxin treatment can cause PR period and reduce ST segment on electrocardiograms.
Digoxin can make false St - T changes on electrocardiograms in exertion testing. These physiological effects reflect the expected effects of the drug and do not show toxicity.
Severe respiratory disease
Patients with severe respiratory diseases may increase the sensitivity of the heart muscle with glycosid digitalis.
Hypotension, hypogsi blood, hypercalcemia
Hypotension causes heart muscle to be sensitive to the effects of cardiac glycosides. Be cautious when using digoxin in patients who use drugs that can cause hypokalemia. Hypotension may also be accompanied by malnutrition, diarrhea, vomiting and may need to reduce the dose in these patients.
Hypotension and hypercalcemia also increases the sensitivity of the heart muscle with cardiac glycosides.
DIRECTOR DIRECTORS
When dehydrated with a direct current in patients who are using digoxin, the drug should be stopped for 24 hours before performing electric shock. In case of emergency, such as cardiac arrest, when trying to sterilize, the lowest energy is effective should be used. Hearturia with DC current is not suitable for the treatment of arrhythmia due to heart glycosides.
Myocardial infarction
Do not combat the use of digoxin in the following stage of myocardial infarction. However, the possibility of arrhythmia arising in patients with hypokalemia after myocardial infarction and unstable cardiovascular ability must be noted. The limits applied later on heart removal with a direct current must also be memorized.
Chronic congestive heart failure
Although many patients with chronic congestive heart failure benefit from the use of acute digoxin, some patients do not improve hemodynamic, continuous or long -term hemodynamic condition. Therefore, it is important to evaluate the reaction of each patient when long -term use Digoxin.
Note: The drug contains lactose -containing drugs, so patients with rare genetic disorders are galactose tolerance, lactase deficiency or glucose - galactose absorption disorders should not use this drug.
The ability to drive and operate machinery
The drug can cause visual disorders and unwanted effects on the central nervous system such as drowsiness, headache, fatigue, sleep, dizziness, disorientation. Patients should avoid driving and operating machinery if the effect occurs on.
Pregnancy
There is no data on whether digoxin has a teratogenic effect. There is no information about the effect of digoxin on human fertility.
Non -contraindicated use of digoxin during pregnancy, although it is difficult to predict the dosage and control in pregnant women compared to women who are not pregnant with some need to increase the dose of digoxin during pregnancy. As with other drugs, only use drugs when considering the expected clinical benefits of using the drug for the mother higher than any risk that may cause the fetus.
Despite predicting the direct effect of digoxin on the uterus can lead to premature and underweight, but it cannot rule out the effects of heart disease. Using Digoxin for the mother has been successfully applied to treat fetal slow heart rate and congestive heart failure.
Side effects in the fetus have been reported in mothers with Digitalis poisoning.
Lactation period
Digoxin is excreted into breast milk, but with normal treatment dose is not sure that there is a risk of acting on breastfed babies, without contraindications to using digoxin during breastfeeding.
Interactive drug
anti -arrhyths
amiodarone: The digoxin concentration in plasma increases significantly when used simultaneously with amiodarone. This is due to reducing the retention of the kidney and no kidneys of digoxin, prolonging the half -life and potentially due to increased absorption. Children are especially sensitive. Digoxin dose should be reduced by 1/3 to 1/2 when used simultaneously with amiodarone.
Disopyramide may change the effect on the heart of digoxin and reduce the distribution of digoxin. Digoxin's starting dose should be reduced in patients taking disopyramide.
flecainide: plasma digoxin concentration increases when used simultaneously with flecainide in patients with high plasma digoxin concentrations or people with atrial atrial dysfunction.
Moracizine: Digoxin and Moracizine have a combination effect on the heart transmission.
Propafenone: plasma digoxin concentration increases when used simultaneously with propafenone. There is a significant change among individuals in terms of this interaction but it is necessary to reduce the dose of digoxin and monitor signs of digoxin poisoning in patients.
quinidine: Excretion through the kidneys and not through the kidney of digoxin decreases when used simultaneously digoxin. Digoxin's secretion and tissue secretion may also decrease. The effect occurs as soon as the quinidine is used for patients stabilizing in digoxin and the concentration of digoxin in plasma usually doubled within 5 days. Digoxin dose should be reduced half when using quinidine and should consider the possibility of anti -arrhythmic drugs.
Antibiotics
Macrolide, Tetracycline antibiotics: metabolism of digoxin into non -activity metabolites in the gastrointestinal tract occurs in about 10% of patients. Simultaneously used with antibiotics of macrolide groups (azithromycin, clarithromycin, erythromycin, telithromycin), Gentamicin or tetracycline for this group of patients can significantly increase clinically digoxin levels in plasma.
Neomycin: The absorption of digoxin in the gastrointestinal tract is inhibited by Neomycin and plasma concentration decreases.
Ritampicin: Digoxin's metabolism may increase when combined with rifampicin. This interaction can increase in patients with renal failure.
trimethoprim: The excretion of the kidneys of digoxin decreases when used simultaneously with trimethoprim. This interaction occurs more significantly in elderly patients or renal failure and need to monitor the concentration of digoxin in plasma.
amphotericin: Hypotension caused by amphotericin may increase digoxin toxicity. Patients need to be monitored and supplemented with potassium as needed.
iTraconazole: may increase the concentration of digoxin in plasma and can be toxic if not reduced the dose of digoxin. ITraconazole may also fight the positive muscle contraction effect of digoxin.
quinine, hydroxychloroquine and chloroquine may increase the concentration of digoxin in plasma by reducing the renal clearance.
Calcium channel blockers
Simultaneous use of diltiazem and digoxin can increase the concentration of digoxin in plasma and increase toxicity.
Nifedipine may increase the concentration of digoxin in plasma but there is a significant change in each patient. Patients with high doses of digoxin or patients with renal failure are at highest risk.
Nisoldipine may also increase the concentration of digoxin in plasma but amlodipine, felodipine, isradipine, lercanidipine, nicardipine, nimodipine and nitrendipine does not seem to have a significant impact on the digoxine level in plasma but should be careful to monitor the effects when using simultaneously.
Verapamil increases plasma digoxin levels by inhibiting the secretion of renal tubules and unintentional discharge of Digoxin. Digoxin dose should be reduced and track plasma concentrations. Verapamil can also increase the atrioventricular block and tachycardia in patients using digoxin.
Calcium salt and substances similar to vitamin D
Intravenous injection of calcium salts for patients using digoxin can lead to dangerous arrhythmia and should be avoided. Vitamin D is similar to that can also increase digoxin toxicity due to increased calcium levels in plasma.
Cardiovascular medicine
ACE inhibitors and Angiotensin II receptor antagonists can cause hyperkalemia, which can reduce the cohesion to the tissue of digoxin, leading to higher serum internal concentrations. These drugs can also cause impaired renal function, leading to increased serum digoxin levels due to reduced kidney secretion.
Concentrated with captopril is associated with an increase in plasma digoxin concentrations in patients with kidney function or severe congestive heart failure.
Using Telmisartan is associated with an increase in plasma digoxin levels. There is no significant clinical interaction recorded with ACE inhibitors or other Angiotensin II receptor antagonists (Cilazapril, Enalapril, Imidapril, Lisinopril, Meexipril, Perindopril, Quinapril, Ramipril and Trandolapril; Candesartan, EproSartan, Irbesartan, Losartan and Losartan, Losartan and Losartan, Losartan and Losartan, Losartan and Losartan Valsartan) but should be careful to monitor the effects when used simultaneously. There is a risk of increased atrial block and slow heart rate when digoxin and beta blockers are used simultaneously.
nitroprusside and hydralazine increase the kidney clearance of digoxin by increasing blood flow through the kidneys and the excretion of the renal tubules and reducing plasma Digoxin concentrations.
Medications used for the central nervous system
St John's: Should avoid using Digoxin with St John's grass because of the significant plasma concentration.
nefazodone, trazodone: Digoxin concentration in plasma increases when used simultaneously with nefazodone or trazodone and may need to reduce the dose of digoxin.
Phenytoin increases the total clearance of digoxin and reduces the sale time, leading to a decrease in plasma concentrations. Phenytoin intravenous injection should not be treated to treat digitalis arrhythmia or in patients with severe cardiac blocks or significant bradycardia due to the risk of cardiac arrest.
Topiramate: simultaneously use Digoxin and Topiramate to reduce the bioavailability of digoxin and patients need to be monitored.
Alprazolam and Diazepam may reduce digoxin clearance, increasing plasma concentrations. Patients need to monitor the toxicity of digoxin, especially patients over 65 years old.
Digoxin can cause adverse effects on short -term control of bipolar disorders in patients treated with lithium.
Diuretics
Reducing potassium caused by acetazolamide, diuretics and thiazide diuretics affect the effect of digoxin on the heart muscle and can also affect the reduction of digoxin secretion in the renal tubules. Patients should be monitored with hypokalemia and potassium supplements as needed. Spironolactone reduces the excretion of digoxin through the kidneys, increasing plasma concentrations. Digoxin should be reduced in sensitive patients.
Medicines on the gastrointestinal tract
Antacids and adsorbent, for example, kaolin, can inhibit the absorption of digoxin through the gastrointestinal tract, leading to a decrease in plasma digoxin levels. Can prevent this interaction by drinking about 2 hours.
Carbenoxolone can cause water retention and hypokalemia, increasing sensitivity to digoxin toxicity.
Digoxin metabolism in the gastrointestinal tract is inhibited by omeprazole, leading to an increase in plasma digoxin levels. The smaller impact has been noticed with Pantoprazole and Rabeprazole.
Sucralfate reduces the absorption of digoxin through the gastrointestinal tract, reducing plasma concentrations.
Plasma digoxin concentrations may be reduced when used simultaneously with sulfasalazine due to reduced absorption.
There is no interaction between Digoxin and other precursors of Mesalazine, Balsalazide.
Lipid control drug
Increased plasma digoxin concentration has been observed in patients using Atorvastatin and may need to reduce the dose of digoxin. Although fluvastatin, pravastatin and simvastatin do not seem to significantly increase the concentration of digoxin in plasma, it should be careful to monitor when used simultaneously. Colestipol and Colestyramin are linked to digoxin in the gastrointestinal tract, reducing the absorption and reduction of plasma digoxin levels. This interaction can be prevented by separating Digoxin and anion exchange resin for about 2 hours.
muscle relaxants
Do not use Edrophonium for atrial patients and tachycardia using digoxin because this combination can cause excessive heart rate and atrial block. Heavy arrhythmias may progress in patients using digoxin if they added additional suxamethium and pancuronium due to the rapid removal of potassium from myocardial cells. Should avoid simultaneous use. Tizanidine has the potential to cause blood pressure and slow heart rate when used simultaneously with digoxin.
nsaid
NSAID has the potential to cause kidney failure, reducing Digoxin's renal clearance with an increase in plasma concentrations. Aspirin, Azapropazone, Diclofenac, Fenbufen, Ibuprofen, Indometacin and Tiaprofenic Acid all show increased plasma digoxin levels in patients with kidney function. Etoricoxib, Ketoprofen, Meloxicam, Piroxicam and Rofecoxib do not increase plasma digoxin levels. Patients treated with Digoxin often need to use NSAIDs and plasma digoxin levels should be monitored when starting or stopping NSAID. Phenylbutazone stimulates digoxin metabolism in the liver, so it is recommended to monitor the plasma concentration of these drugs when used simultaneously.
Other drugs
Acarboose inhibits the absorption of digoxin in the gastrointestinal tract, leading to lower plasma concentrations.
Increased plasma digoxin concentrations when used with prazosin.
Carbimazole or penicillamine may reduce the concentration of digoxin in plasma.
Changes in thyroid function may affect sensitivity to independent digoxin with plasma concentrations.
Increased plasma digoxin concentration has been reported when cyclosporin is used for patients using digoxin due to reduced renal excretion. Patients need to be closely monitored and adjust the dose of digoxin as needed.
corticosteroids cause potassium, sodium and water retention increases the risk of digoxin and heart failure. Patients with prolonged corticosteroids should be closely monitored.
Many cytotoxic drugs damage intestinal mucosa, reduce digoxin absorption and reduce plasma concentrations. This effect is reversed right after stopping using cytotoxic drugs.
Beta -2 -selective agonists can cause hypoemia to increase the sensitivity to rhythmic due to Digoxin. Simultaneous use with Salbutamol is also associated with an increase in plasma digoxin levels.
Persevereous nerve stimulants have a direct transmission effect that can promote arrhythmia and hypotension, leading to or worse the arrhythmia. Simultaneous use of digoxin and sympathetic nerve stimulants can increase the risk of arrhythmia.
A combination can increase the effect of digoxin when used simultaneously
Propantheline, Epoprostenol, Vasopressin receptor antagonists (Tolvaptan and Conivaptan), Carvedilol, Ritonavir/Ritonavir, Taleprevir, DroneDarone, Ranolazine, Lapatinib and Ticagrelor.
Concomitant use of Digoxin and Sennoside may increase the risk of Digoxin poisoning in patients with heart failure.
Patients with digoxin are greatly affected by the effects of hyperkalemia due to increased Suxamethonium concentration.
Simultaneous use Lapatinib with oral digoxin leads to an increase in auc of digoxin. Caution should be careful when using Digoxin with Lapatinib.
The combination can reduce the effect of digoxin when using the line
antacids, some laxatives, kaolin - pectin, acarbose, neomycin, penicillamine, rifampicin, some cytostatic, metoclopramide, sulfasalazine, adrenaline, salbutamol, cholestyramine, phenytoin, sting st John (hypericum Perforatum), bupropion and supplements through the intestinal tract.
Storage
In a cool dry place, temperatures below 30 ° C, avoid light.
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