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Brand Name :
Digitaline Welcker Tab, AWD
Synonyms :
Digitoksin, digitoxin, Digitoxina, Digitoxine, Digitoxinum, Digitoxoside
Class :
Anti-Arrythmic Drugs of class IV, Cardiotonic Agents, Enzyme inhibitors, Cardiac glycosides, Cardiac Ionotropic Agent, Digitalis glycosides
Brand Name :
Digitaline Welcker Tab, AWD
Synonyms :
Digitoksin, digitoxin, Digitoxina, Digitoxine, Digitoxinum, Digitoxoside
Class :
Anti-Arrythmic Drugs of class IV, Cardiotonic Agents, Enzyme inhibitors, Cardiac glycosides, Cardiac Ionotropic Agent, Digitalis glycosides
Dosage Forms & StrengthsÂ
TabletsÂ
62.5 mcgÂ
125 mcgÂ
250 mcgÂ
0.1 mgÂ
Injection, SolutionÂ
0.25 mg/mLÂ
0.1 mg/mLÂ
0.25 mg/mLÂ
0.05 mg/mLÂ
Congestive Heart Failure (CHF)Â
Rapid digitalization with an oral loading dose of 600 mcg, which after 4-6 hours is followed by 400 mcg, followed by 200 mcg for every 4 -6 hours if necessary, depending on the patient's condition and slow digitalization with an oral dose of 200 mcg twice daily for four days
The maintenance dose is 50 to 300 mcg once every 24 hours, whereas the usual dose is 150 mcg every 24 hours
Dose Adjustments
Renal dose adjustments
In renal impairment, if the CrCl is less than or below 10 mL/min, the recommended dose is 50% or 75% of the usual dose
Rapid digitalization with an oral loading dose of 600 mcg, which after 4-6 hours is followed by 400 mcg, followed by 200 mcg for every 4 -6 hours if necessary, depending on the patient's condition and slow digitalization with an oral dose of 200 mcg twice daily for four days
The maintenance dose is 50 to 300 mcg once every 24 hours, whereas the usual dose is 150 mcg every 24 hours
Dose Adjustments
Renal dose adjustments
In renal impairment, if the CrCl is less than or below 10 mL/min, the recommended dose is 50% or 75% of the usual dose
Injectable solutions are administered that is also divided into several fractions in the intervals of 6 to 8 hours of time which is maintained for children below 10 years of age. This is used only for rapid digitalization in which IV is preferred better than IM. Usual dose which is recommended is 20 mcg/kg.Â
Congestive Heart Failure (CHF)Â
Injectable solutions are administered and divided into fractions at 6 to 8 hours, maintained for children below 10
It is used only for rapid digitalization, in which IV is preferred over IM
The usual dose which is recommended is 20 mcg/kg
Refer to the adult dosingÂ
the serum concentration of digitoxin is increased by flibanserin. Assessment of serum concentrations of digitoxin is recommended before therapy
serum concentration of cardiac glycosides is increased by amiodarone
side effects of cardiac glycosides are increased by bretylium
may increase the QTc-prolonging effect of each other when combined
may increase the QTc-prolonging effect of each other when combined
may increase the QTc-prolonging effect of each other when combined
may increase the QTc-prolonging effect of each other when combined
may increase the QTc-prolonging effect of each other when combined
the concentration of digitoxin in serum is decreased by kaolin
thyroid products decrease the concentration of cardiac glycosides in serum
thyroid products decrease the concentration of cardiac glycosides in serum
thyroid products decrease the concentration of cardiac glycosides in serum
thyroid products decrease the concentration of cardiac glycosides in serum
digitoxin's AV-blocking action is increased when clonidine is used in combination
may increase the serum concentration of cardiac glycosides
may increase the serum concentration of cardiac glycosides
may increase the serum concentration of cardiac glycosides
l-methylfolate-pyridoxal 5′-phosphate-methylcobalamine
may increase the arrhythmogenic effect of cardiac glycosides
may increase the arrhythmogenic effect of cardiac glycosides
may increase the arrhythmogenic effect of cardiac glycosides
may increase the arrhythmogenic effect of cardiac glycosides
may increase the arrhythmogenic effect of cardiac glycosides
may increase the arrhythmogenic effect of cardiac glycosides
may increase the arrhythmogenic effect of cardiac glycosides
may have an increased arrhythmogenic effect when combined with cardiac glycosides
may have an increased arrhythmogenic effect when combined with cardiac glycosides
may have an increased arrhythmogenic effect when combined with cardiac glycosides
may have an increased arrhythmogenic effect when combined with cardiac glycosides
may have an increased arrhythmogenic effect when combined with cardiac glycosides
may have an increased arrhythmogenic effect when combined with cardiac glycosides
may decrease the levels of serum concentration of Cardiac Glycosides
may decrease the levels of serum concentration of Cardiac Glycosides
may decrease the levels of serum concentration of Cardiac Glycosides
may decrease the levels of serum concentration of Cardiac Glycosides
calcium salts have the potential to intensify the arrhythmogenic effect of cardiac glycosides
calcium salts have the potential to intensify the arrhythmogenic effect of cardiac glycosides
calcium salts have the potential to intensify the arrhythmogenic effect of cardiac glycosides
calcium salts have the potential to intensify the arrhythmogenic effect of cardiac glycosides
calcium salts have the potential to intensify the arrhythmogenic effect of cardiac glycosides
When mometasone furoate is used together with digitoxin, this leads to enhanced risk or seriousness of adverse outcomes
digitoxin serum concentration is reduced by acarbose
side effects of adenosine are increased by digitoxin
the serum concentration of digitoxin is increased by enasidenib
When ponesimod is used together with digitoxin, this leads to enhanced risk or seriousness of bradycardia
may diminish the serum concentration of 5-Aminosalicylic Acid Derivatives
may diminish the serum concentration of 5-Aminosalicylic Acid Derivatives
When digitoxin is used together with givinostat, this leads to enhanced risk or seriousness of Qtc prolongation
When digitoxin is used together with oleandomycin, this leads to enhanced concentration serum of digitoxin
When digitoxin is used together with ridaforolimus, this leads to enhanced concentration serum of digitoxin
side effects of digitoxin can be increased when calcimax syrup is used in combiantion
side effects of digitoxin can be increased when calcimax syrup is used in combiantion
side effects of digitoxin can be increased when calcimax syrup is used in combiantion
side effects of digitoxin can be increased when calcimax syrup is used in combiantion
side effects of digitoxin can be increased when calcimax syrup is used in combiantion
side effects of digitoxin can be increased when calcimax syrup is used in combiantion
side effects of digitoxin can be increased when calcimax syrup is used in combiantion
may increase the adverse/toxic effect of cardiac glycosides
may increase the adverse/toxic effect of cardiac glycosides
may increase the adverse/toxic effect of cardiac glycosides
the serum concentration of digitoxin can be decreased when it is combined with apalutamide
the serum concentration of digitoxin can be increased when it is combined with apixaban
the hazard or seriousness of QTc prolongation can be heightened when apomorphine is combined with digitoxin
the hazard or seriousness of QTc prolongation can be heightened when arformoterol is combined with digitoxin
the hazard or seriousness of cardiac arrhythmia can be heightened when atracurium is combined with digitoxin
the serum concentration of digitoxin can be increased when it is combined with belinostat
the serum concentration of digitoxin can be increased when it is combined with belumosudil
the serum concentration of bendamustine can be increased when it is combined with digitoxin
digitoxin may decrease the cardiotoxic activities of bevacizumab
the metabolism of digitoxin can be diminished when combined with bifonazole
When digitoxin is used together with halometasone, this leads to enhanced risk or seriousness of adverse outcomes
may increase the serum concentration of cardiac glycosides
may increase the serum concentration of cardiac glycosides
may increase the serum concentration of cardiac glycosides
may increase the serum concentration of cardiac glycosides
may increase the serum concentration of cardiac glycosides
may increase the serum concentration of cardiac glycosides
may increase the serum concentration of cardiac glycosides
may increase the serum concentration of cardiac glycosides
may increase the serum concentration of cardiac glycosides
may increase the serum concentration of cardiac glycosides
may decrease the absorption of cardiac glycosides
may enhance the AV-blocking effect of cardiac glycosides
may enhance the AV-blocking effect of cardiac glycosides
may enhance the AV-blocking effect of cardiac glycosides
may enhance the AV-blocking effect of cardiac glycosides
may enhance the AV-blocking effect of cardiac glycosides
may enhance the arrhythmogenic effect of cardiac glycosides
may enhance the arrhythmogenic effect of cardiac glycosides
may enhance the arrhythmogenic effect of cardiac glycosides
may enhance the arrhythmogenic effect of cardiac glycosides
may enhance the arrhythmogenic effect of cardiac glycosides
may enhance the arrhythmogenic effect of cardiac glycosides
may decrease the absorption of cardiac glycosides
may increase the serum concentration of cardiac glycosides
may increase the serum concentration of cardiac glycosides
may enhance the AV-blocking effect of cardiac glycosides
may enhance the AV-blocking effect of cardiac glycosides
may enhance the AV-blocking effect of cardiac glycosides
may enhance the AV-blocking effect of cardiac glycosides
may enhance the AV-blocking effect of cardiac glycosides
may increase the arrhythmogenic effect of cardiac glycosides
may increase the arrhythmogenic effect of cardiac glycosides
may increase the arrhythmogenic effect of cardiac glycosides
may increase the arrhythmogenic effect of cardiac glycosides
may increase the arrhythmogenic effect of cardiac glycosides
may increase the levels of serum concentration of cardiac glycosides
may increase the levels of serum concentration of cardiac glycosides
may increase the levels of serum concentration of cardiac glycosides
may increase the levels of serum concentration of cardiac glycosides
may increase the levels of serum concentration of cardiac glycosides
may increase the arrhythmogenic effect of cardiac glycosides
may increase the arrhythmogenic effect of cardiac glycosides
may increase the arrhythmogenic effect of cardiac glycosides
may increase the arrhythmogenic effect of cardiac glycosides
may increase the arrhythmogenic effect of cardiac glycosides
may enhance the arrhythmogenic effect of cardiac glycosides
may enhance the arrhythmogenic effect of cardiac glycosides
may enhance the arrhythmogenic effect of cardiac glycosides
may enhance the arrhythmogenic effect of cardiac glycosides
may enhance the arrhythmogenic effect of cardiac glycosides
may enhance the arrhythmogenic effect of cardiac glycosides
may enhance the adverse/toxic effect of cardiac glycosides
may enhance the adverse/toxic effect of cardiac glycosides
may enhance the adverse/toxic effect of cardiac glycosides
may enhance the adverse/toxic effect of cardiac glycosides
may increase the risk of adverse effect of cardiac glycosides
may increase the risk of adverse effect of cardiac glycosides
may increase the risk of adverse effect of cardiac glycosides
may enhance the serum concentration of telmisartan
may increase the arrhythmogenic effect of Vitamin D analogs
may increase the toxic effect of thiazide and thiazide like diuretics
lisinopril/hydrochlorothiazideÂ
may increase the toxic effect of thiazide and thiazide like diuretics
may increase the risk of adverse effect of cardiac glycosides
may have an increased adverse effect when combined with cardiac glycosides
may increase the adverse effect of Amphotericin B
may increase the toxic effect when combined
5-Aminosalicylic Acid Derivatives: they may diminish the serum concentration of cardiac glycosides
5-Aminosalicylic Acid Derivatives: they may diminish the serum concentration of cardiac glycosides
may increase the AV-blocking effect when combined
may enhance the serum concentration of each other when combined
may diminish the concentration of serum when combined with cardiac glycosides
neomycin/polymyxin B/bacitracin topical
may diminish the concentration of serum when combined with cardiac glycosides
may diminish the concentration of serum when combined with cardiac glycosides
may diminish the concentration of serum when combined with cardiac glycosides
may diminish the concentration of serum when combined with cardiac glycosides
may have an increased arrhythmogenic effect when combined with cardiac glycosides
may have an increased arrhythmogenic effect when combined with cardiac glycosides
may have an increased arrhythmogenic effect when combined with cardiac glycosides
may have an increased arrhythmogenic effect when combined with cardiac glycosides
may have an increased arrhythmogenic effect when combined with cardiac glycosides
It may enhance the risk of adverse effects when combined with cardiac glycosides
It may enhance the risk of adverse effects when combined with cardiac glycosides
It may enhance the risk of adverse effects when combined with cardiac glycosides
It may enhance the risk of adverse effects when combined with cardiac glycosides
It may enhance the risk of adverse effects when combined with cardiac glycosides
may have an increased arrhythmogenic effect when combined with cardiac glycosides
calcium salts enhance the arrhythmogenic effects of cardiac glycosides
calcium salts enhance the arrhythmogenic effects of cardiac glycosides
calcium salts enhance the arrhythmogenic effects of cardiac glycosides
calcium salts enhance the arrhythmogenic effects of cardiac glycosides
macrolide antibiotics increase cardiac glycoside serum concentration
may have an increased adverse effect when combined with cardiac glycosides
may have an increased adverse effect when combined with cardiac glycosides
the risk of adverse effects may be increased
synergistic effects may occur
ispaghula husk may lower or decrease the rate of GI absorption of cardiac glycosides
the metabolism of digitoxin can be heightened when combined with apremilast
the metabolism of digitoxin can be diminished when combined with aprepitant
the hazard or seriousness of QTc prolongation can be heightened when aripiprazole is combined with digitoxin
the hazard or seriousness of QTc prolongation can be heightened when digitoxin is combined with aripiprazole lauroxil
the metabolism of digitoxin can be heightened when combined with armodafinil
the serum concentration of digitoxin can be increased when it is combined with arsenic trioxide
the hazard or seriousness of QTc prolongation can be heightened when digitoxin is combined with artemether
the serum concentration of digitoxin can be increased when it is combined with asciminib
the hazard or seriousness of QTc prolongation can be heightened when digitoxin is combined with asenapine
the serum concentration of digitoxin can be increased when it is combined with astemizole
the serum concentration of digitoxin can be increased when it is combined with asunaprevir
the metabolism of digitoxin can be diminished when combined with atazanavir
atenolol may heighten the arrhythmogenic activities of digitoxin
the hazard or seriousness of QTc prolongation can be heightened when atomoxetine is combined with digitoxin
the serum concentration of digitoxin can be diminished when it is combined with belzutifan
bendroflumethiazide may heighten the hypokalemic activities of digitoxin
betaxolol may heighten the arrhythmogenic activities of digitoxin
the serum concentration of digitoxin can be increased when it is combined with betrixaban
the metabolism of digitoxin can be heightened when combined with bexarotene
the metabolism of digitoxin can be diminished when combined with bicalutamide
the hazard or seriousness of QTc prolongation can be heightened when digitoxin is combined with bilastine
the serum concentration of binimetinib can be increased when it is combined with digitoxin
the serum concentration of digitoxin can be diminished when it is combined with bismuth subsalicylate
the therapeutic efficacy of digitoxin can be increased when used in combination with bisoprolol
digitoxin may decrease the cardiotoxic activities of bleomycin
the metabolism of digitoxin can be diminished when combined with boceprevir
the serum concentration of digitoxin can be heightened when it is combined with brentuximab vedotin
Actions and Spectrum:Â
Actions:Â
Reversal of Na/Ca exchange by digitoxin is done by inhibiting NA/K ATPase pump which increases calcium levels in myocardial cell which shows positive inotropism that is enhanced contractility. It also blocks AV conduction and bradycardia by showing negative chronotropy.Â
Spectrum:Â
Indication of digitoxin which is a cardiac glycoside is mainly for the treatment of congestive heart failure. Spectrum of digitoxin can be seen in treating cardiac arrhythmias, atrial fibrillation, supraventricular tachycardia. It is also used in combination with other agents that treat arrhythmias and heart failure.Â
Frequency Not DefinedÂ
NauseaÂ
VomitingÂ
AnorexiaÂ
DiarrhoeaÂ
Abdominal painÂ
HeadacheÂ
Facial painÂ
ConvulsionsÂ
Skin rashÂ
GynacomastiaÂ
Atrial TachycardiaÂ
FatigueÂ
WeaknessÂ
DizzinessÂ
DrowsinessÂ
DisorientationÂ
Mental confusionÂ
Bad dreamsÂ
DeliriumÂ
Acute psychosisÂ
HallucinationsÂ
Blurred visionÂ
Color visionÂ
VasoconstrictionÂ
Transient hypotensionÂ
Local irritationÂ
Hypersensitivity reactionsÂ
ThrombocytopeniaÂ
Heart failureÂ
Supraventricular arrythmiasÂ
Conduction defectsÂ
Black Box Warning:Â
Patients who have ventricular fibrillation should not use digitoxin. digitoxin is not recommended in patients who are allergic to it.
Contraindication/Caution:Â
ContraindicationsÂ
CautionsÂ
Pregnancy consideration:Â Â
No data is available regarding the administration of the drug during pregnancy.Â
Breastfeeding warnings:Â Â
No data is available regarding the excretion of drug in breast milk.Â
Pregnancy category:Â
Category A: well-controlled and satisfactory studies show no risk to the fetus in the first or later trimester.Â
Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women.Â
Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.   Â
Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.   Â
Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.   Â
Category N: No data is available for the drug under this category.Â
Pharmacology:Â
In case of heart failure, digitoxin promotes calcium influx through a sodium-calcium exchange pump, which leads to improved contractility. This happens through the inhibition pf Na/K ATPase pump in myocardium.Â
In case of supra ventricular arrhythmias, when AV node conduction is suppressed, it leads to refractory period enhancement and gives positive inotropic effect that results in reduction of conduction velocity, vagal tone enhancement, ventricular rate to speed up atrial arrhythmias. Atrial fibrillation reduces sensitivity and gives more tolerance to higher digitoxin serum concentrations.Â
Pharmacodynamics:Â
Contractility is increased when digitoxin increases intracellular sodium levels which increases influx of calcium which increases cardiac output with reduction in ventricular filling pressures. Vaga mimetic effects that is AV Node inhibition on the AV node is shown by digitoxin. onset of action takes place in 2 to 12 hours and duration will be 3 weeks.Â
Pharmacokinetics:Â
AbsorptionÂ
Onset of action after oral administration is 1 to 2 hours and for IV it is 5 minutes to 1 hour. Peak time is 2 to 8 hours after oral administration and 1 to 6 hours after IV injection.Â
It is readily and completely absorbed from upper small intestine of the GIT.Â
DistributionÂ
Plasma Protein-bound is 90%Â
Bioavailability is 60 to 80%Â
The volume of distribution of digitoxin is 6 to 7 L/kg.Â
MetabolismÂ
digitoxin is extensively metabolized in the liver and enterohepatic recycling takes place.Â
Elimination and ExcretionÂ
The half-life is 36-48 hours.Â
The drug is excreted 50 to 70 % in urine as unchanged.Â
Administration:Â
Administration of digitoxin can be oral or also via IV route which is better than IM route because of pain it gives in that location. Loading dose can be divided into fractions and can be maintained at certain intervals of time after careful assessment of patient’s clinical response.
Patient information leafletÂ
Generic Name: digitoxinÂ
Pronounced: di-JI-TOX-inÂ
Why do we use digitoxin?Â
digitoxin is a cardiac glycoside that is used in the treatment of Congestive Heart Failure, Cardiac arrythmias, Supraventricular tachycardia and Atrial fibrillation.Â
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