Digitoxin belongs to the class of drugs known as cardiac glycosides and is occasionally used instead of Digoxin. Digitoxin acts on cardiac muscles regulating its contraction and electrical activity thus controlling heart rate and force of contraction. Digitoxin is used in the management of symptomatic congestive heart failure, arrhythmia, angina pectoris, cardiogenic shock and prophylactically in those with heart disease to prevent deterioration during surgery or pregnancy.
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Digitoxin is used together with other drugs (Beta blockers, Angiotensin Converting Enzyme Inhibitors and diuretics) in the treatment of symptomatic congestive heart failure with left ventricular impairment. It reduces hospital stay and alleviation of symptoms. Digitoxin is also used in the management of patients with atrial fibrillation and atrial flutter by controlling the ventricular rate. Digitoxin with beta blockers is used in the treatment of angina pectoris that is associated with cardiomegaly and heart failure. Digitoxin plays a role prophylactically to prevent heart failure or arrhythmias in patients with heart disease undergoing a physiological stressful event, e.g. surgery, pregnancy or significant illness.
- Heart failure
- Cardiogenic shock
Digitoxin should be taken as prescribed by your doctor. Inform your doctor if you"re pregnant or intend to get pregnant and other medications that you may be using. The dosage is guided by the particular indication, co-morbidities, response to the medication, age and weight. Digitoxin is available as an intravenous injection of 20/ml or in oral tablets of 50, 100, 150 and 20. The usual adult dose for digitalization:
- Rapid: Oral, 600 stat, then 400 after four to six hours and 200 after another four to six hours, followed by a daily maintenance dose as deemed necessary, or
- Slow: Oral, 200 twice a day for four days, followed by a daily maintenance dose as deemed necessary
- Maintenance: Oral, 50 to 300 once a day, adjusted as need be.
Digitoxin Side Effects
Side effects of Digitoxin are usually dose dependent (seen in doses above the therapeutic range) and observed in those with comorbidities, concurrent drug use (diuretics) or hypersensitive. Children"s manifestation may differ from that of adults. Some side effects in adults that require urgent medication include:
- Cardiovascular effects: slow or irregular heartbeat, fainting and palpitation
- Central nervous system manifestations: anxiety, confusion, dizziness, apathy, hallucinations, blurred vision, headache and weakness
- Gastrointestinal effects: nausea, vomiting, diarrhea, abdominal pain
- Skin rash and bleeding tendencies.
- Enlargement of male breasts, especially in chronic use.
- Some side effects in children that necessitate urgent medical attention:
- More common are cardiac manifestations: tachycardia and arrhythmias
- Less common: apathy, confusion, dizziness, anorexia, nausea and vomiting
Digitoxin has been reported to interact with various medications and foods. Some medications potentiate the effect of Digitoxin, others result in electrolyte variations and arrhythmias or reduce the clearance of Digitoxin thus increase their bioavailability. Some these drugs include:
- Ethacrynic acid
- Some foods should be avoided when using Digitoxin. These include:
- Salt substitutes containing potassium
- Garlic and ginger
- Excess salt/sodium
- Milk, calcium containing dairy products, antacids 2 hours before using Digitoxin
- Bran and high fiber within 2 hours of taking Digitoxin