Digoxin
DigoxinPharmacological action
Warm glycoside. Enlarges force of warm reductions, slows down AV conductivity and CARDIAC CONTRACTIONS RATE. Moderate diuretic an effect has.
Preparation action begins through 0.5-2 h after reception; the maximum effect develops during 2-6 h.
Indications
- A chronic heart failure;
- Disturbances of a warm rhythm (a constant of the form of a ciliary arrhythmia, an atrial flutter, a supraventricular tachycardia).
Dosage regimen
At therapy by Digoxin distinguish "sating" and "supporting" phases of treatment. In a "sating" phase of treatment Digoxin accept in doses which provide achievement of therapeutic concentration in a blood plasma during precisely certain time interval, in a "supporting" phase concentration of digoxin in plasma is supported at therapeutic level.
Dosage regimen establish individually according to age of the patient, body mass, function of kidneys, severity level of disease and other indicators.
In a sating phase of treatment the dose for adults makes 0 mg (2-4 tablets.) then prescribe on 250 mkg (1 tablet.) through everyone 6 h before achievement of desirable therapeutic effect. The average daily dose makes 1-1 mg (4-6 tablets). Constant concentration of digoxin in plasma is reached usually within 7 days. Depending on the reached medical effect of a dose correct.
In a supporting phase of treatment the average dose makes 125-250 mkg (1/2-1 tablets.)/days
With renal insufficiency individual correction of a regimen of dosage is required to patients of advanced age and patients.
Side effect
From cardiovascular system: disturbances of a rhythm of heart (which first of all are overdosage signs).
From the alimentary system: absence of appetite, a nausea, vomiting, a diarrhoeia.
From party TSNS: delicacy, feeling of weariness, apathy, a headache, sight disturbances (a diplopia, a photophobia, a flicker of "front sights" before eyes), depression, a psychosis.
From cardiovascular system: disturbances of a warm rhythm.
From endocrine system: at long treatment by a preparation the gynecomastia is possible.
Allergic reactions: on occasion - a dermal itch, an urticaria.
From hemopoiesis system: on occasion - a thrombocytopenia, petechias.
By-effects become perceptible at preparation application in high doses is more often.
Children. At children the by-effects which have been not bound to a condition of cardiovascular system, meet very seldom, basically various disturbances of a warm rhythm concern signs of a poisoning with digoxin.
Contraindications
- Fibrillation of ventricles;
- The expressed bradycardia;
- AV blockade (alternating full blockade, blockade of II degree);
- The isolated mitral stenosis;
- A hypertrophic subaortal stenosis;
- An acute myocardial infarction;
- An astable stenocardia;
- A WPW-syndrome;
- A cardiac tamponade;
- A ventricular tachycardia;
- A hypersensibility to digoxin.
Pregnancy and lactemia
Digoxin gets through a placental barrier and is defined in foetus plasma in the same concentration, as at mother.
Digoxin is allocated with thoracal milk in insignificant quantities, nevertheless at application of Digoxin in a lactemia (thoracal feeding) the control of the CARDIAC CONTRACTIONS RATE at the child is necessary.
Special indicatings
The probability of occurrence intoxications raises at a hypopotassemia, a hypomagnesiemia, a hypercalcemia, a hypernatremia, a hypothyrosis, the expressed dilatation of cavities of heart, pulmonary heart, a myocarditis, at elderly patients.
Use in pediatrics
Digoxin in the given medicinal form in children's practice is not used.
At application of digoxin for children the by-effects which have been not bound to a condition of cardiovascular system, became perceptible seldom.
Results of experimental researches
In the researches spent on laboratory animals, mutagen and cancerogenic action of a preparation are not taped.
Overdosage
Symptoms: absence of appetite, a nausea, vomiting, a hiccup, paroxysmal pains in a stomach bottom, a diarrhoeia, a headache, delicacy, confusion of consciousness, a bradycardia, disturbances of a warm rhythm, depression, dream disturbances; sight disturbances (a diplopia, a photophobia) are possible.
Treatment: a gastric lavage with use of the activated coal (20-30 g on 1 l of water), application of saline laxatives (magnesium Zinci sulfas, sodium Zinci sulfas - to dissolve 15-30 g laxative in 1 glass of warm water).
Medicinal interaction
At simultaneous application of Digoxin with loopback diuretics, salts of lithium and Amphotericinum B the potassium maintenance in a blood plasma decreases, sensitivity to digoxin raises and the risk of development intoxications amplifies.
At simultaneous application of Digoxin with calcium salts the calcium maintenance in a blood plasma is enlarged, sensitivity to digoxin raises and the risk of development intoxications amplifies.
At simultaneous application of Digoxin with Chinidinum, Amiodaronum, verapamil, indometacin, slow down deducing of digoxin from an organism and its concentration in a blood plasma raises.
At simultaneous application of Digoxin with erythromycin, Tetracyclinum, gentamycin concentration of digoxin in a blood plasma is enlarged.
At simultaneous application of Digoxin with Colestyraminum; the purgatives containing magnesium; the antacids containing aluminium, calcium, magnesium or bismuth; Metoclopramidum absorption of digoxin from GASTROINTESTINAL TRACT decreases and its concentration in a blood plasma decreases.
At simultaneous application of Digoxin with rifampicin, Sulfasalazinum the metabolism of digoxin amplifies and its concentration in a blood plasma decreases.
Conditions and periods of storage
The preparation should be stored in a place inaccessible to children at temperature from 15 to 30 C. The Period of validity - 3 years.
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