Digoxin from what these tablets. Use in elderly patients. Preparations with the same active ingredient

Many of our compatriots are not only well aware of such a disease as chronic heart failure, but are also personally familiar with it. Favorable factors for the development of this disease, experts call bad habits, poor quality food and wrong image life. being exposed long time Under the influence of these factors, the heart subsequently becomes unable to restore normal functioning.

However, there is a solution for this category of patients. Pharmacies have special drugs that can help patients restore heart function. Among the proposed drugs are quite popular is Digoxin.. But due to a number of features, it is advisable to use it only on the recommendation of the attending physician.

Digoxin: release form and composition

In pharmacies, this drug is offered in the form of tablets of small diameter. The main active ingredient in the composition of the drug is the substance digoxin. One tablet of the drug contains 250 mg of this substance. Also included in the preparation are auxiliary components:

• talc;
• anhydrous colloidal silicon;
• gelatin;
• corn starch;
• lactose monohydrate;
• magnesium stearate.

The drug is available in cardboard packs or plastic bottles.

Digoxin is a drug categories of cardiac glycosides. Tablets have the ability to restore the work of the heart. If you turn to the instructions, then from it you can find out that this tool also significantly enhances contractility myocardium. This in turn leads to an increase in stroke volume. Additionally, the drug reduces the volume of the heart, resulting in a decrease in myocardial oxygen demand.

The drug in question can also be prescribed to patients who have been diagnosed with atrial tachyarrhythmia. The active ingredient in this drug is able to slow down the frequency of ventricular contractions and improve intracardiac geodynamics. But you need to take it with caution, as in case of an overdose, side effects may occur.

Digoxin: indications for use

This drug is very popular not only among doctors, but also among patients. The reviews say that the pills have a positive effect on the work of the heart. Patients with chronic heart failure especially need this drug if they have clinical manifestations this disease. In a positive way, the drug also affects the condition of patients who have been diagnosed with a tachysystolic form of atrial fibrillation. This is especially true for patients who similar pathology developed in conditions of progressive chronic heart failure.

The drug Digoxin in tablets can not be prescribed as an independent medicinal product. The instructions say that it can only be used as part of the complex therapy of chronic heart failure. With the help of these pills, you can restore the heart rhythm, as well as good health sick. At the same time, these pills are not able to return the heart to its previous state.

Contraindications

Not all patients can take Digoxin tablets. The doctors' reviews say that a specialist can decide on the appointment of this medication only after the patient has passed complete examination organism. The reason for this is the presence of this drug a large number contraindications. First of all, this is Wolff-Parkinson-White syndrome, glycoside intoxication, intermittent complete blockade. Also a sufficient reason for refusing to prescribe this medication is the patient's hypersensitivity to constituent components medication.

Experts also identify a number of conditions in which Digoxin should be prescribed with caution. Before approving the use of the drug, the doctor must weigh the potential benefits and harms of such treatment. If the patient has conditions such as cardiac amyloidosis, arteriovenous shunt, unstable angina, acute infarction myocardial infarction, subaortic stenosis, he can take pills only after receiving approval from the attending physician. In the treatment of Digoxin, an overdose can be one of the possible causes occurrence adverse reactions. Therefore, it is so important to follow the recommendations of the instructions and the doctor.

Digoxin: instructions for use

In order for the drug to benefit the patient, it is necessary to know how to take these pills. Referring to the manual, it contains exact dosage for different clinical situations. Digoxin is a drug for internal use. Do not forget that it belongs to the group of cardiac glycosides. And this means that it is necessary to take the dosage calculation seriously, taking into account individual characteristics the patient's body. If the patient took cardiac glycosides before contacting a specialist, then Digoxin tablets are prescribed to him in a reduced dosage.

Digoxin: dosage

When treating adults the dosage is calculated in such a way that the medicine brings them the desired therapeutic effect. The decision to carry out rapid digitalization by a doctor can only be taken in emergency cases when the patient's condition worsens. In this case, he is prescribed a medicine with a dosage of 1.25 mg 2 times a day. Particular attention should be paid to the fact that before each new dose it is necessary to make an ECG. When there is evidence of an improvement in the patient's heart, he is prescribed supportive treatment. At the same time, it is allowed to reduce the dosage of the drug.

Most often, patients are prescribed slow digitalization. This means that the patient is prescribed Digoxin for a course of 5-7 days. According to available reviews, this method of treatment allows you to maintain the patient's well-being for a long time. For such patients, a dosage of 250-500 mcg is selected. The medicine must be taken once a day.

Use during pregnancy and lactation

To date, experts have enough information about the impact of Digoxin tablets on the health of pregnant and lactating women. According to the results of the clinical research it was possible to establish that the main active ingredient in the composition of this drug can penetrate through the placental barrier to the fetus, and into breast milk. During childbirth, the content of the main component of the drug in the blood serum of the newborn and mother is the same.

If we evaluate this drug for safety of use, then it can be attributed to Category C. If you rely on the reviews of experts, then women should be prescribed pills during gestation and during breastfeeding only in extreme cases. It is worth deciding on such a step only if the medicine can bring much great benefit for the health of the mother than harm to the child.

At the same time, today there is no verified information about the impact of the drug on the health of children. That is why the use of Digoxin tablets for children under the age of 18 is not recommended.

Digoxin side effects

Usually, patients complain of a deterioration in well-being when they exceed the recommended dosage. Before starting to take this drug, patients are strongly advised to carefully read the instructions containing indications for use and reviews. In case of drug intoxication The following symptoms may indicate this:

• polytopic ventricular extrasystole;
• nodal tachycardia;
• sinoauricular blockade;
• ventricular paroxysmal tachycardia.

Also, the drug may affect the work digestive system causing symptoms such as nausea, vomiting, and diarrhea. Sometimes during development similar states Patients may lose their appetite completely. In some cases, anorexia may develop.

More Digoxin tablets, which are taken without regard to indications, can cause disturbances in the work of the central nervous system. This can be indicated by symptoms such as:

• visual hallucinations;
• confusion;
• depressive syndrome;
• headache;
• sleep disturbance.

Having found any of the above symptoms, the patient should immediately stop taking Digoxin tablets. From the feedback of patients taking this drug, you can find out that the body returns to its normal state when the patient stops taking this drug.

Analogues

Sometimes there are situations when pharmacies do not have a drug based on digoxin. In this case, the doctor may choose analogues for the patient, which will have the same therapeutic effect on the body as the drug being replaced. Among the most famous, it is worth highlighting the medicine. Magnesium hydroxide is the main active ingredient in its composition. It also contains excipients - microcrystalline cellulose, magnesium stearate, potato starch, acetylsalicylic acid.

The drug Cardiomagnyl can be used as part of therapy various diseases of cardio-vascular system. It can be prescribed to patients and in order to prevent thrombosis and recurrent myocardial infarction.

Price

The drug Digoxin tablets refers to drugs available for a wide range of patients. In pharmacies, one package of this medicine offered at a price of 50 r. If you wish, you can save on the purchase of this product if you order it in an online pharmacy.

Reviews

It will soon be a year since I take this medicine. I drink these pills according to the scheme that my doctor prescribed to me - half a pill 3 times a day. Then I pause for 2 days, after which I continue taking the medicine. And so every 5 days. At first, I felt discomfort, which was associated with nausea, poor sleep, and sweating. But over time, everything disappeared, the drug helps well with coronary artery disease and arrhythmias. However, I read in reviews that it is undesirable to take this remedy for more than 3 months in a row, since in this case irreversible processes in the body may begin. Now I'm thinking about what drug can replace it.

Svetlana

I have strong suspicions that this is drug. It was prescribed to my grandmother at a dosage of one tablet a day. But after 3 days from the start of treatment, she had glitches. She became delusional, and she completely lost sleep. After reading the instructions, we learned that the elderly should be given this remedy in half a tablet. ​ So strong effect psychosis manifested itself due to the fact that, in addition to this drug, the grandmother took other pills.

We immediately stopped giving her this remedy, and she immediately felt better. After the drug was discontinued, glitches and nonsense disappeared. Now, if we give her this remedy again, then only a quarter of a tablet once every two or three days. Otherwise, she will again have trouble sleeping and hallucinations.

Alexander

My good friend was diagnosed with cardiomyopathy 4 years ago. He is now taking Digoxin and Preductal. Additionally, he was prescribed Furosemide. So far, his condition is fairly stable. During the year, he goes to the hospital three or four times to remove fluid from the body. Although he has long considered himself an invalid, he is already in his fifth year, and his condition is quite tolerable. Without Digoxin, he would have felt much worse. Now he has an incredible heart large sizes and is constantly growing. Recently, he developed diabetes due to taking strong drugs. He has no problems with other organs. The only thing that can save him is a heart transplant.

Used to normalize the rhythm of the heart cardiac glycoside Digoxin - instructions for use of the drug contains information about its action, method and doses of administration. High bioavailability increases the effect of the drug, and the patient will quickly feel an improvement in the condition of the heart. Digoxin will help with heart failure, atrial fibrillation, myocardial overload.

What is Digoxin?

Medication Digoxin is a drug that is actively used for the treatment of cardiac arrhythmias, heart failure. The drug belongs to the group of purified glycosides. Digoxin directly affects the contraction of the heart muscle, increasing it. This effect increases cardiac output in insufficiency. Moreover, when the heartbeat is irregular, the drug slows down and normalizes it.

Compound

The active substance of the drug is digoxin (digoxin) - White powder, which is extracted from the foxglove plant. 1 ml of solution and 1 tablet contain 0.25 mg of the substance. Substance renders positive action on the state of the heart, because it has an inotropic, vasodilating, mild diuretic effect. The medication contains talc, glucose, starch, calcium stearate. Depending on the form of release and the manufacturer, excipients vary.

Release form

The drug Digoxin is produced in the form of tablets, ampoules with a solution for intravenous administration:

• Tablets have White color and flat cylindrical shape. On one side is the letter "D". A contour package with cells contains 10 pieces, and a cardboard pack contains from 1 to 5 such cells. 50 tablets can be in polymer or glass jars, they are sold in a cardboard bundle in the amount of 1 or 2 pieces. The same happens with polypropylene cases.
• The solution for intravenous administration is produced in 5 ampoules in a contour package with cells, which are in a cardboard box of 1 or 2 pcs.

Mechanism of action

Digoxin is a drug plant origin, which has a strong cardiotonic effect, therefore its use increases the stroke and minute volume of blood, and the need for myocardial cells in oxygen decreases. The contraction of the heart muscle improves after taking Digoxin. In addition, the drug enhances the severity of the negative dromo- and chronotropic effect - the sinus node reduces the frequency of generation of an electrical impulse and the speed of its conduction through the cardiac system, and the activity of the sinoatrial node slows down.

What is it used for?

For the treatment of cardiac disorders, Digoxin is used - the instruction for the use of the drug contains more exact list indications for use:

• along with other medicines complex treatment with heart failure chronic stage;
• tachyarrhythmia;
• preparation for surgery or childbirth in violation of the heart.

Instructions for use Digoxin

For effective treatment heart rhythm disorders use Digoxin - its instructions for use contain important information about the method of administration and doses. For each of the release forms, this instruction differs in the duration of the course and other aspects of drug administration. Before you start taking it, you need to visit a doctor, since only he can write a prescription with the drug and other medicines for complex therapy. In case of overdose, use an antidote.

Tablets

To find out how to take Digoxin tablets, you need to consult a doctor for advice, and then read the instructions for use of the drug. The dose of the drug is selected individually, based on the state of health and age of the patient:

• Up to 10 years, the dose is calculated approximately 0.03-0.05 mg per 1 kg of the child's weight.
• With rapid digitalization, Digoxin tablets are used 2 times a day: 0.75-1.25 mg. After achieving the effect, the patient continues treatment with medications that support him.
• During the period of slow digitalization, the dose of the drug is 0.125-0.5 mg per day, the course lasts a week. During this period, the maximum effect is manifested.

In ampoules

Digoxin in ampoules provides faster absorption of the active substance. Recommended dose:

• Fast digitalization. 3 times a day, 0.25 mg. After that, therapy is carried out to maintain the effect with injections of 0.125-0.25 mg per day.
• Slow digitalization. For 1-2 doses, up to 0.5 mg of Digoxin is administered.

Side effects

With signs of an overdose, the presence of contraindications or improper use of the drug Digoxin, side effects occur:

• Heart: ventricular extrasystole, bigeminia, nodal tachycardia, atrioventricular block, atrial flutter, ST segment decrease on the ECG (electrocardiogram), bradycardia, cardiac arrhythmias, mesenteric vascular thrombosis.
• Nervous system: fatigue, insomnia, headache, dizziness, decreased vision, mania, depression, neuritis, fainting, confusion, euphoria, disorientation, hallucinations, xanthopsia.
• Gastrointestinal tract (gastrointestinal tract): nausea, urge to vomit, diarrhea, signs of anorexia, abdominal pain, intestinal necrosis.
• The system of hemostasis and organs of bleeding: blood from the nose, petechiae.
• Endocrine system: at long-term use gynecomastia occurs.
• Allergy, skin rash, urticaria.

Contraindications

Digoxin is contraindicated in patients with high sensitivity to individual components or allergies. Contraindications also include:

• glycoside intoxication;
• Wolff-Parkinson-White syndrome;
• AV (atrioventricular) blockade of the second stage;
• intermittent complete blockade;
• GV (breastfeeding);
• heart rhythm disturbances (with ventricular tachycardia, bradycardia, extrasystole);
• myocardial infarction during an exacerbation;
• unstable angina;
• subaortic hypertrophic stenosis;
• mitral stenosis.

During pregnancy, taking the medication is possible only if the fetus is at risk. In other cases, the drug is contraindicated due to its ability to penetrate the hematoplacental barrier, causing the concentration of the active substance in the fetal blood serum. The same effect occurs with GW. With caution, the drug is prescribed to patients with AV blockade of the 1st degree, isolated mitral stenosis, cardiac asthma, hypoxia, electrolyte disturbances (hypokalemia), hypothyroidism. In the elderly, the drug is taken under the close supervision of a physician.

Interaction

When the drug interacts with other drugs, side effects may increase or the effect of medications may decrease. For each drug, the result of the interaction is different:

• Bioavailability will decrease with simultaneous reception Digoxin and activated charcoal, antacids, kaolin, cholestyramine, astringent drugs (drugs), cholestyramine, metoclopramide, prozerin.
• If the drug is taken with antibiotics that have an effect on the intestinal microflora, bioavailability will increase.
• Beta-blockers, verapamil will enhance the negative chronotropic and reduce the inotropic effect.
• An increased risk of developing arrhythmias with the simultaneous administration of Digoxin and sympathomimetics, diuretics, glucocorticosteroids, amphotericin B, insulin.
• The introduction of calcium and potassium salts into the veins of patients who take the medication often leads to a pronounced toxic effect of the drug.

Analogues

Digoxin has no direct analogues. There are similar drugs, the main information about which is contained in the table.

Price

You can buy the drug in the online store or visit the nearest pharmacy in the city. In addition, most pharmacy chains carry out online sales, where you can order any product from an extensive catalog that is not on the counter and read reviews about medicines. Medicines will be delivered to you within a week. specified address pharmacy for you to pick it up. Often the cost of drugs for such orders is an order of magnitude lower than in retail stores.

Video: drug Digoxin

To restore myocardial rhythm in heart failure, doctors prescribe medicinal product Digoxin (Digoxin) full course. This medication represents the pharmacological group of cardiac glycosides, has systemic action in the body. Before you start conservative treatment heart failure and disturbed rhythm of myocardial contractions in this way, you need to individually consult with a cardiologist, carefully study the instructions.

Composition and form of release

The drug Digoxin is produced in the form of white flat-cylindrical tablets and a clear solution for intravenous administration. Features of the chemical composition:

Mechanism of action of Digoxin

The drug, being a cardiotonic agent, increases functional activity hearts. The active substance is a glycoside of the foxglove plant. Pharmacological properties:

1. inotropic effect. The concentration of calcium ions in cardiomyocytes increases, activating contractions of muscle fibers. Systole (myocardial contraction) becomes more powerful, diastole (relaxation) time is prolonged.
2. vasoconstrictor effect. The drug increases the tone blood vessels stimulates blood flow and myocardial contractility.
3. chronotropic effect. The drug, having a direct effect on the structures of the autonomic nervous system and the sinus node, reduces the heart rate.

With progressive hypoxia (lack of oxygen), Digoxin increases lung oxygenation by acting on chemoreceptors. Digitalis woolly reduces the speed of nerve impulses passing through the atrioventricular node. The active substance is adsorbed from the digestive canal, penetrating from the intestine into the bloodstream. Eating slows down the absorption of components, but does not affect the bioavailability. The drug is excreted from the body unchanged in the urine. The half-life lasts up to 50 hours.

Indications for use Digoxin

The drug Digoxin is a cardiac glycoside, which acts as part of complex therapy. The instructions contain medical indications on the use of this medication:

• congestive heart failure;
• supraventricular tachycardia;
• atrial fibrillation;
• tachysystolic arrhythmia (atrial flutter);
• circulatory failure in heart disease.

Method of application and dosage

According to the instructions for use, Digoxin is intended for oral administration in a full course. The doctor determines the course of treatment individually, based on the diagnosis, the form of release of the drug, and the characteristics of the affected organism. With a recent treatment with cardiac glycosides, the cardiologist adjusts the daily dose (first reduces, then gradually increases).

Digoxin in ampoules

Healing solution intended for intravenous or intramuscular injection jet or drip. Daily doses depend on the diagnosis and age of the patient, are described in detail in the instructions for use:

• supraventricular arrhythmia of a paroxysmal form: intravenous administration, drip, dosage - 0.25–1 mg per day;
• moderately rapid digitalization: intravenous administration, daily dosage- 0.25 mg three times a day, then maintenance therapy - once a day, 0.125-0.25 mg;
• slow digitalization: intravenous administration, daily dosage - 0.5 mg for 1 - 2 approaches.

This form of release is intended for oral use. Recommended dosages for patients over 10 years of age are described in detail in the instructions:

• moderately fast digitalization: emergency therapy - 0.75–1.25 mg in 2 sets;
• slow digitalization: a weekly course is required to take 0.125-0.5 mg 1 time per day, then switch to maintenance therapy;
• maintenance therapy: 0.125–0.75 mg in a long course as recommended by the attending physician.

special instructions

According to the instructions for use, daily doses of Digoxin are adjusted for certain categories of patients. For example, for patients with chronic heart failure, the recommended dosage should not exceed 0.25 mg, with a weight of more than 85 kg - up to 0.375 mg. Daily dose for elderly patients is 0.0625-0.125 mg. The manual also contains other recommendations:

1. During drug therapy it is required to regularly conduct an ECG, monitor the concentration of electrolytes in the blood serum.
2. At kidney failure in order to avoid acute intoxication of the body, the dosage of the drug is reduced: with a creatinine clearance (CC) of 50-80 ml / min - by 50%, CC less than 10 ml / min - by 75%. In addition, it is necessary to control the concentration of Digoxin in the blood serum once every 2 weeks.
3. The risk of intoxication with glycosides increases with hypothyroidism, hypomagnesemia, cor pulmonale, hypokalemia, severe dilatation of the cavities of the heart, hypercalcemia, hypernatremia, myocarditis.
4. Patients with contact lenses during treatment, it is required to temporarily abandon their daily wear, switch to glasses.
5. The chemical composition of the drug contains potato starch, sucrose, lactose, glucose, which is important to remember when prescribing the drug to patients diabetes.
6. The use of Digoxin in idiopathic subaortic stenosis provokes an increase in symptoms of obstruction.
7. The dosage of the drug recommended in the instructions is reduced in case of chronic cor pulmonale, impaired water and electrolyte balance, coronary insufficiency, renal or hepatic insufficiency.
8. Taking the medication disrupts psychomotor functions, depresses the functioning of the nervous system, therefore, when treating with Digoxin, it is required to refuse to drive a vehicle, not to engage in work that requires a high concentration of attention.

During pregnancy

detailed instructions on the use of Digoxin reports that this medication is not recommended for use during gestation and during breastfeeding. The active substance penetrates the placental barrier, is excreted in high concentrations with mother's milk. If treatment is necessary, lactation must be temporarily stopped and the baby should be transferred to adapted mixtures. Pregnant women are prescribed another medication with a more gentle effect on the fetus.

drug interaction

Since cardiac glycosides are becoming part of complex therapy, it is important to study information about drug interaction. Such information is provided in the instructions for use of Digoxin:

1. It is forbidden to combine the indicated medication with tannins, acids, alkalis, salts heavy metals.
2. Symptoms of glycoside intoxication increase with simultaneous use with calcium salts, insulin, diuretics, sympathomimetics, glucocorticosteroids.
3. The concentration of Digoxin in the blood increases in combination with Quinidine, Verapamil, Amiodarone and Erythromycin.
4. Simultaneous use of cardiac glycoside with Propranolol, Reserpine, Phenytoin increases the risk of ventricular arrhythmias.
5. The combination with Amphotericin B, sodium phosphate increases the likelihood of glycoside intoxication against the background of hypokalemia.
6. Phenylbutazone, barbiturates, potassium preparations reduce the therapeutic effect of the drug, and in combination with the antibiotics Erythromycin and Gentamicin, the concentration of glycoside in the blood plasma increases.
7. Simultaneous use of the drug with Cholestyramine, magnesium laxatives, Cholestipol impairs the absorption of Digoxin in the intestine.
8. The metabolism of cardiac glycosides is accelerated by drugs such as Rifampicin, Sulfosalazine.
9. Hormones thyroid gland enhance cellular metabolism, in combination with Heparin, the anticoagulant effect of the latter weakens.
10. To reduce the toxic effects of glycosides, a solution of magnesium sulfate is prescribed.

Side effects of Digoxin

At correct application the indicated medication is well tolerated by the body. Doctors do not exclude the occurrence side effects at the beginning of the course:

• digestive tract: anorexia, nausea, vomiting, diarrhea, gastralgia, signs of dyspepsia, necrosis of part of the intestine;
• cardiovascular system: sinus bradycardia, paroxysmal ventricular tachycardia, ventricular extrasystole, nodal tachycardia, atrial fibrillation or flutter;
• sensory organs: flies before the eyes, seeing objects in yellow-green hues (xanthopsia), decreased visual acuity;
• nervous system: neuritis, dizziness, paresthesia, sciatica, confusion, fainting, visual hallucinations, a state of euphoria;
• hematopoietic organs: petechiae, nosebleeds, thrombocytopenia;
• allergic reactions: pruritus and rash, urticaria, swelling, hyperemia of the epidermis, erythema skin;
• others: hypokalemia, gynecomastia.

Overdose

With a systematic excess of the recommended doses of glycoside in the body, side effects increase.. The patient complains of pronounced signs of dyspepsia, atrioventricular blockade, peripheral paresthesia, delirious psychosis, drowsiness, signs of depression. In such a clinical case, it is necessary to use a specific antidote: sodium or calcium edetate (EDTA), sodium dimercaptopropanesulfonate, antibodies to digoxin. Further, intestinal sorbents are prescribed, for example, Activated carbon. Treatment is symptomatic.

Contraindications

Digoxin in the form of tablets or solution is not allowed to be used by all patients. The instructions for use contain a capacious list medical contraindications:

• Adams-Stokes-Morgagni syndrome;
• isolated stenosis mitral valve;
• ventricular tachycardia;
• Wolff-Parkinson-White syndrome;
• bradycardia;
• glycoside intoxication;
• constrictive pericarditis;
• hypertrophy of the interventricular septum;
• cardiomyopathy;
• atrioventricular block;
• hypercalcemia, hyperkalemia;
• aneurysm thoracic aorta;
• acute myocardial infarction;
• amyloidosis of the heart;
• hypertrophic obstructive cardiomyopathy;
• unstable angina;
• tamponade of the heart muscle;
• hypertrophic subaortic stenosis;
• ventricular fibrillation;
• recurrent diseases of the liver, kidneys;
• age up to 3 years;
• hypersensitivity to the active substances of the glycoside.

Terms of sale and storage

Digoxin in solution and tablet form is a prescription drug. According to the instructions, it is required to store the medicine in a cool, dry place, away from small children. The shelf life of the tablets is 3 years, the solution is 5 years.

Analogues

If the drug is not suitable or worsens the patient's well-being, the doctor introduces a replacement. Reliable analogues of Digoxin:

1. Novodigal. The drug is characterized by the rapid accumulation of components in the tissues, is available in the form of a solution. According to the instructions, the therapeutic effect occurs 1-2 hours after the application of a single dose.
2. Celanide. A reliable substitute for Digoxin in the form of tablets, recommended for tachycardia, heart failure of 2 and 3 degrees. Before the onset of the cumulative effect, 4-6 hours pass.

Structural formula

Russian name

Latin name of the substance Digoxin

chemical name

(3beta,5beta,12beta)-3-[(O-2,6-Dideoxy-beta-D-ribo-hexopyranosyl-(1"4)-O-2,6-dideoxy-beta-D-ribo-hexopyranosyl- (1"4)-2,6-dideoxy-beta-D-ribo-hexopyranosyl)oxy]-12,14-dihydroxycard-20(22)-enolide

Gross formula

Pharmacological group of the substance Digoxin

Nosological classification (ICD-10)

CAS code

Characteristics of the substance Digoxin

Glycoside of foxglove leaves. White crystalline powder. Slightly soluble in water, practically insoluble in alcohol.

Pharmacology

It has a positive inotropic, negative chrono- and dromotropic, positive bathmotropic (in toxic doses Oh). Inhibits Na + -K + -ATPase of the membrane of cardiomyocytes, increases the intracellular concentration of sodium and indirectly - calcium. Calcium ions, interacting with the troponin complex, eliminate its inhibitory effect on the complex of contractile proteins. Well absorbed when taken orally (65-80%). T 1/2 is 34-51 hours. It is evenly distributed over organs and tissues. Part stands out in duodenum with bile and reabsorbed. Able to accumulate (to a somewhat lesser extent than digitoxin). It binds to plasma proteins by 35-40%. It is excreted mainly in the urine (during pregnancy - slowly). In patients with chronic heart failure, it causes indirect vasodilation, moderately increases diuresis (mainly due to improved hemodynamics). After oral administration, the cardiotonic effect develops after 1-2 hours, reaches a maximum within 8 hours, after intravenous administration - after 20-30 minutes. In patients with unimpaired liver and kidney function, the action stops after 2-7 days. The sensitivity of the myocardium to digoxin (and other glycosides) is influenced by the electrolyte composition of the plasma ( low content K + and Mg 2+ , increasing Ca 2+ and Na + increases sensitivity).

Application of the substance Digoxin

Chronic heart failure, atrial fibrillation, supraventricular paroxysmal tachycardia, atrial flutter.

Contraindications

Hypersensitivity, glycoside intoxication, WPW syndrome, AV block II-III st. (unless an artificial pacemaker is installed), intermittent complete blockade.

Application restrictions

AV blockade of the 1st degree, the likelihood of unstable conduction in the AV node, a history of Morgagni-Adams-Stokes attacks, hypertrophic obstructive cardiomyopathy, isolated mitral stenosis with low heart rate, cardiac asthma with mitral stenosis (in the absence of tachysystolic form of atrial fibrillation), acute myocardial infarction , unstable angina, arteriovenous shunt, hypoxia, heart failure with impaired diastolic function ( restrictive cardiomyopathy, cardiac amyloidosis, constrictive pericarditis, cardiac tamponade), extrasystoles, severe dilatation of the heart cavities, cor pulmonale, electrolyte disturbances (hypokalemia, hypomagnesemia, hypercalcemia, hypernatremia), hypothyroidism, alkalosis, myocarditis, renal / hepatic failure, obesity, elderly age.

Use during pregnancy and lactation

Side effects of Digoxin

From the nervous system and sensory organs: headache, dizziness, sleep disturbance, drowsiness, weakness, confusion, delirium, hallucinations, depression; possible violation of color vision, decreased visual acuity, scotoma, macro- and micropsia.

From the digestive tract: nausea, vomiting, anorexia, diarrhea, abdominal pain.

From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): bradycardia, ventricular extrasystole, AV blockade, thrombocytopenia, thrombocytopenic purpura, epistaxis, petechiae.

Others: gynecomastia with prolonged use, intestinal ischemia, rash.

Interaction

Adrenomimetics increase the likelihood of developing arrhythmias; antiarrhythmic and anticholinesterase drugs - bradycardia; glucocorticoids, saluretics and other agents that contribute to the loss of potassium, calcium preparations - glycoside intoxication. Chlorpromazine reduces the cardiotonic effect; laxatives, antacids, products containing aluminum, bismuth, magnesium - absorption. Rifampicin speeds up metabolism.

Overdose

Symptoms: AV blockade, vomiting, nausea, arrhythmia.

Treatment: potassium preparations, dimercaprol, ethylenediaminetetraacetate.

Digoxin is a cardiac glycoside used as a cardiotonic agent for the treatment of chronic heart failure (as part of complex therapy) and some types of arrhythmias. This drug refers to the so-called "A" list (which previously had the alternative name "poisonous substances") and is released from pharmacies strictly by prescription. The drug has a positive inotropic effect, ie. it increases the force of heart contractions. This is due to a direct inhibitory effect on the membrane Na + / K + -ATPase of the muscle cells of the heart, which entails an increase in the content of sodium ions inside the cells with a simultaneous decrease in the content of potassium ions. Against the background of an excess of sodium ions in the cardiomyocyte, calcium channels open, through which calcium ions immediately rush into the cell. As a result of this calcium “abundance”, myocardial contractility and stroke volume increase. But the final systolic and diastolic blood volumes decrease, which, combined with an increase in cardiac tone, leads to a reduction in the size of the myocardium and a decrease in its oxygen demand. Digoxin is endowed with negative chronotropic (reduces heart rate) and dromotropic (reduces conduction) effects. With atrial tachyarrhythmia, the drug slows down the frequency of ventricular contractions, lengthens the diastolic period, improves hemodynamic parameters inside the heart and throughout the body as a whole.

It has a positive bathmotropic effect, increasing the excitability of the heart. It manifests itself mainly when using subtoxic and toxic doses of the drug. Digoxin has a direct vasoconstrictive effect, which is especially pronounced against the background of the absence of peripheral congestive edema. However, indirect vasodilating effect(response to an increase in cardiac output and a decrease in excessive sympathetic stimulation of vascular tone), as a rule, prevails over direct vasoconstrictor action resulting in a decrease in overall peripheral vascular resistance.

Digoxin is available in two dosage forms: tablets and solution for intravenous administration. As with any cardiac glycoside, the dose of the drug should be selected with extreme caution in relation to each individual patient, and if he already took cardiac glycosides before prescribing digoxin, then the dose of the latter should be reduced. During the entire course of medication, the patient must be under close medical supervision to prevent the development of negative side effects. It should be noted that digoxin is incompatible with injectables calcium.

Pharmacology

Digoxin is a cardiac glycoside. It has a positive inotropic effect. This is due to the direct inhibitory effect on the Na+/K+-ATPase of the cardiomyocyte membrane, which leads to an increase in the intracellular content of sodium ions and, accordingly, a decrease in potassium ions. As a result, the content of sodium ions in the cardiomyocyte increases, which leads to the opening of calcium channels and the entry of calcium ions into cardiomyocytes. An excess of sodium ions also leads to an acceleration of the release of calcium ions from the sarcoplasmic reticulum. An increase in the content of calcium ions leads to the elimination of the action of the troponin complex, which has a depressing effect on the interaction of actin and myosin.

As a result of an increase in myocardial contractility, the stroke volume of blood increases. The end systolic and end diastolic volumes of the heart decrease, which, along with an increase in myocardial tone, leads to a reduction in its size and thus to a decrease in myocardial oxygen demand. It has a negative chronotropic effect, reduces excessive sympathetic activity by increasing the sensitivity of cardiopulmonary baroreceptors.

A negative dromotropic effect is manifested in an increase in the refractoriness of the atrioventricular (AV) node, which allows it to be used for paroxysms of supraventricular tachycardia and tachyarrhythmias.

With atrial tachyarrhythmia, it helps to slow down the frequency of ventricular contractions, lengthens diastole, and improves intracardiac and systemic hemodynamics.

A positive bathmotropic effect is manifested when prescribing subtoxic and toxic doses.

It has a direct vasoconstrictor effect, which is most clearly manifested in the absence of congestive peripheral edema.

At the same time, the indirect vasodilatory effect (in response to an increase in minute blood volume and a decrease in excessive sympathetic stimulation of vascular tone) usually prevails over a direct vasoconstrictor effect, resulting in a decrease in total peripheral vascular resistance (OPVR).

Pharmacokinetics

suction out gastrointestinal tract(GIT) - variable, makes up 70-80% of the dose and depends on the motility of the gastrointestinal tract, dosage form, concomitant food intake, and interaction with other drugs.

Bioavailability 60-80%. At normal acidity gastric juice a small amount of digoxin is destroyed; in hyperacid conditions, a larger amount of it can be destroyed. For complete absorption, sufficient exposure in the intestine is required: with a decrease in gastrointestinal motility, bioavailability is maximum, with increased peristalsis- minimum. The ability to accumulate in tissues (cumulate) explains the lack of correlation at the beginning of treatment between the severity of the pharmacodynamic effect and its concentration in blood plasma. Cmax of digoxin in blood plasma is reached after 1-2 hours. Communication with blood plasma proteins is 25%. Apparent V d - 5 l / kg.

Metabolized in the liver. Digoxin is excreted mainly by the kidneys (60-80% unchanged). T 1/2 is about 40 hours. Excretion and T 1/2 is determined by kidney function. The intensity of renal excretion is determined by the amount of glomerular filtration. In mild chronic renal failure, the decrease in renal excretion of digoxin is compensated by the hepatic metabolism of digoxin to inactive metabolites. In hepatic insufficiency, compensation occurs due to increased renal excretion of digoxin.

Release form

Excipients: sucrose 17.5 mg, lactose 40 mg, potato starch 7.93 mg, dextrose 2.5 mg, talc 1.4 mg, calcium stearate 420 mcg.

10 pieces. - cellular contour packings (1) - packs of cardboard.
10 pieces. - cellular contour packings (2) - packs of cardboard.
10 pieces. - cellular contour packings (3) - packs of cardboard.

Dosage

Method of application - inside.

As with all cardiac glycosides, the dose should be selected with caution, individually for each patient.

If the patient before the appointment of digoxin took cardiac glycosides, in this case, the dose of the drug must be reduced.

Adults and children over 10 years old

The dose of Digoxin depends on the need to quickly achieve a therapeutic effect.

Moderately fast digitalization (24-36 h) is used in emergency cases

The daily dose is 0.75-1.25 mg, divided into 2 doses, under ECG control before each subsequent dose.

After reaching saturation, they switch to maintenance treatment.

Slow digitalization (5-7 days)

The daily dose of 0.125-0.5 mg is prescribed 1 time per day. within 5-7 days (until saturation is reached), after which they switch to maintenance treatment.

Chronic heart failure

In patients with chronic heart failure, Digoxin should be used in small doses: up to 0.25 mg per day. (for patients weighing more than 85 kg up to 0.375 mg per day). In elderly patients, the daily dose of digoxin should be reduced to 0.0625-0.0125 mg (1/4; 1/2 tablets).

Supportive care

The daily dose for maintenance therapy is set individually and is 0.125-0.75 mg. Maintenance therapy is usually carried out for a long time.

Children aged 3 to 10 years

The loading dose for children is 0.05-0.08 mg/kg/day; this dose is prescribed for 3-5 days with moderately rapid digitalization or for 6-7 days with slow digitalization. The maintenance dose for children is 0.01-0.025 mg / kg / day.

Impaired kidney function

If the excretory function of the kidneys is impaired, it is necessary to reduce the dose of digoxin: with a creatinine clearance (CC) value of 50-80 ml / min, the average maintenance dose (SPD) is 50% of the SPD for people with normal renal function; with CC less than 10 ml / min - 25% of the usual dose.

Overdose

Symptoms: loss of appetite, nausea, vomiting, diarrhea, abdominal pain, intestinal necrosis; ventricular paroxysmal tachycardia, ventricular extrasystole (often polytopic or bigeminy), nodal tachycardia, SA block, atrial fibrillation and flutter, AV block, drowsiness, confusion, delirious psychosis, decreased visual acuity, staining visible objects in yellow-green color, flickering of "flies" before the eyes, perception of objects in a reduced or enlarged form; neuritis, sciatica, manic-depressive psychosis, paresthesia.

Treatment: discontinuation of the drug Digoxin, the appointment of activated charcoal (to reduce absorption), the introduction of antidotes (sodium dimercaptopropanesulfonate, sodium calcium edetate (EDTA), antibodies to digoxin), symptomatic therapy. Perform continuous ECG monitoring.

In cases of hypokalemia, potassium salts are widely used: 0.5-1 g of potassium chloride is dissolved in water and taken several times a day up to a total dose of 3-6 g (40-80 mEq of potassium ions) for adults, subject to adequate kidney function. In emergency cases, intravenous drip of 2% or 4% potassium chloride solution is indicated. The daily dose is 40-80 mEq K+ (diluted to a concentration of 40 mEq K+ per 500 ml). The recommended rate of administration should not exceed 20 mEq / h (under ECG control).

In cases of ventricular tachyarrhythmias, slow intravenous administration of lidocaine is indicated. In patients with normal heart and kidney function, slow intravenous administration (over 2-4 minutes) of lidocaine at an initial dose of 1-2 mg/kg of body weight is usually effective, followed by a transition to drip administration at a rate of 1-2 mg/day. min. In patients with impaired renal and / or cardiac function, the dose should be reduced accordingly.

In the presence of II-III degree AV blockade, lidocaine and potassium salts should not be prescribed until an artificial pacemaker is installed.

During treatment, it is necessary to monitor the content of calcium and phosphorus in the blood and daily urine.

There is experience in the use the following drugs with a possible positive effect: beta-blockers, procainamide, bretylium tosylate and phenytoin. Cardioversion can induce ventricular fibrillation.

Atropine is indicated for the treatment of bradyarrhythmias and AV blockade. With AV block II-III degree, asystole and suppression of activity sinus node installation shown artificial driver rhythm.

Interaction

With the simultaneous appointment of digoxin with drugs that cause electrolyte imbalance, in particular hypokalemia (for example, diuretics, glucocorticosteroids, insulin, beta-agonists, amphotericin B), the risk of arrhythmias and the development of other toxic effects of digoxin increases. Hypercalcemia can also lead to the development of toxic effects of digoxin, therefore intravenous administration of calcium salts should be avoided in patients taking digoxin. In these cases, the dose of digoxin must be reduced. Some drugs can increase the concentration of digoxin in the blood serum, for example, quinidine, blockers of "slow" calcium channels (especially verapamil), amiodarone, spironolactone and triamterene.

The absorption of digoxin in the intestine can be reduced by the action of cholestyramine, colestipol, aluminum-containing antacids, neomycin, tetracyclines. There is evidence that the simultaneous use of spironolactone not only changes the concentration of digoxin in the blood serum, but can also affect the results of the method for determining the concentration of digoxin, therefore, it is required Special attention when evaluating the results.

Decreased bioavailability: activated charcoal, astringents, kaolin, sulfasalazine (binding in the lumen of the gastrointestinal tract); metoclopramide, neostigmine methyl sulfate (prozerin) (increased gastrointestinal motility).

Increased bioavailability: Broad-spectrum antibiotics that suppress intestinal microflora(reduction of destruction in the gastrointestinal tract).

Beta-blockers and verapamil increase the severity of the negative chronotropic effect, reduce the strength of the inotropic effect.

Inducers of microsomal oxidation (barbiturates, phenylbutazone, phenytoin, rifampicin, antiepileptic drugs, oral contraceptives) can stimulate the metabolism of digoxin (if they are canceled, digitalis intoxication is possible). When used simultaneously with digoxin below these medicines their interaction is possible, as a result of which the therapeutic effect or a side or toxic effect of digoxin is manifested: mineralo-, gluco-corticosteroids; amphotericin B for injection; carbonic anhydrase inhibitors; adrenocorticotropic hormone (ACTH); diuretic drugs that promote the release of water and potassium ions (bumetanide, ethacrynic acid, furosemide, indapamide, mannitol and thiazide derivatives); sodium phosphate.

Hypokalemia caused by these drugs increases the risk toxic action digoxin, therefore, while using them with digoxin, constant monitoring of the concentration of potassium in the blood is required.

St. John's wort preparations: co-administration reduces the bioavailability of digoxin, increasing the rate of hepatic metabolism and significantly reduces the concentration of digoxin in blood plasma.

Amiodarone: Increases the plasma concentration of digoxin to toxic levels. The interaction of amiodarone and digoxin inhibits the activity of the sinus and atrioventricular nodes of the heart and the conduction of the nerve impulse along the conduction system of the heart. Therefore, having appointed amiodarone, digoxin is canceled or its dose is reduced by half;

Preparations of salts of aluminum, magnesium and other drugs used as antacids can reduce the absorption of digoxin and reduce its concentration in the blood;

Simultaneous use with digoxin: antiarrhythmic drugs, calcium salts, pancuronium bromide, rauwolfia alkaloids, suxamethonium iodide and sympathomimetics can provoke the development of disorders heart rate therefore, in these cases, it is necessary to monitor the patient's cardiac activity and ECG;

Kaolin, pectin and other adsorbents, cholestyramine, colestipol, laxatives, neomycin and sulfasalazine reduce the absorption of digoxin and thereby reduce its therapeutic effect;

Blockers of "slow" calcium channels, captopril - increase the concentration of digoxin in the blood plasma, therefore, when using them together, the dose of digoxin should be reduced so that the toxic effect of the drug does not appear;

Edrophonium chloride (an anticholinesterase agent) increases the tone of the parasympathetic nervous system, so its interaction with digoxin can cause severe bradycardia;

Erythromycin - improves the absorption of digoxin in the intestine;

Heparin - digoxin reduces the anticoagulant effect of heparin, so its dose has to be increased;

Indomethacin reduces the excretion of digoxin, therefore, the risk of toxic effects of the drug increases;

A solution of magnesium sulfate for injection is used to reduce the toxic effects of cardiac glycosides;

Phenylbutazone - reduces the concentration of digoxin in the blood serum;

Potassium salt preparations: they should not be taken if conduction disturbances on the ECG have appeared under the influence of digoxin. However, potassium salts are often prescribed along with digitalis preparations to prevent heart rhythm disturbances;

Quinidine and quinine - these drugs can dramatically increase the concentration of digoxin;

Spironolactone - reduces the rate of release of digoxin, so it is necessary when joint application adjust the dose of the drug;

Thallium chloride - in the study of myocardial perfusion with thallium preparations, digoxin reduces the degree of accumulation of thallium in the areas of damage to the heart muscle and distorts the study data;

Thyroid hormones - when they are prescribed, metabolism increases, so the dose of digoxin must be increased.

Side effects

Reported side effects are often initial signs overdose.

Digitalis intoxication:

From the side of the cardiovascular system: ventricular paroxysmal tachycardia, ventricular extrasystole (often bigeminia, polytopic ventricular extrasystole), nodal tachycardia, sinus bradycardia, sinoauricular (SA) blockade, atrial fibrillation and flutter, AV blockade; on the ECG - a decrease in the ST segment with the formation of a biphasic T wave.

From the side digestive tract: anorexia, nausea, vomiting, diarrhea, abdominal pain, bowel necrosis.

From the side of the central nervous system: sleep disturbances, headache, dizziness, neuritis, sciatica, manic-depressive syndrome, paresthesia and fainting, in rare cases(mainly in elderly patients with atherosclerosis) - disorientation, confusion, monochrome visual hallucinations.

On the part of the senses: staining of visible objects in yellow-green color, flickering of "flies" before the eyes, decreased visual acuity, macro- and micropsia.

Allergic reactions are possible: skin rash, rarely - urticaria.

On the part of the hematopoietic organs and the hemostasis system: thrombocytopenic purpura, epistaxis, petechiae.

Others: hypokalemia, gynecomastia.

Indications

As part of the complex therapy of chronic heart failure II (in the presence of clinical manifestations) and III-IV functional class according to the NYHA classification; tachysystolic form of atrial fibrillation and flutter of paroxysmal and chronic course(especially in combination with chronic heart failure).

Contraindications

Hypersensitivity to the drug, glycoside intoxication, Wolff-Parkinson-White syndrome, II degree atrioventricular block, intermittent complete block, children under 3 years of age, patients with rare hereditary diseases: fructose intolerance and glucose/galactose malabsorption syndrome or sucrase/isomaltase deficiency; lactase deficiency, lactose intolerance, glucose-galactose malabsorption.

With caution (comparing benefit / risk): AV blockade of the 1st degree, sick sinus syndrome without a pacemaker, the likelihood of unstable conduction along the AV node, indications of a history of Morgagni-Adams-Stokes attacks, hypertrophic obstructive cardiomyopathy, isolated mitral stenosis with rare heart rate , cardiac asthma in patients with mitral stenosis (in the absence of a tachysystolic form of atrial fibrillation), acute myocardial infarction, unstable angina pectoris, arteriovenous shunt, hypoxia, heart failure with impaired diastolic function (restrictive cardiomyopathy, cardiac amyloidosis, constrictive pericarditis, cardiac tamponade), extrasystole , pronounced dilatation of the cavities of the heart, "pulmonary" heart.

Electrolyte disorders: hypokalemia, hypomagnesemia, hypercalcemia, hypernatremia. Hypothyroidism, alkalosis, myocarditis, advanced age, renal and / or liver failure, obesity.

Application features

Use during pregnancy and lactation

Digitalis preparations cross the placenta. During childbirth, the concentration of digoxin in the blood serum of the newborn and mother is the same. Digoxin on the safety of its use during pregnancy according to the classification of administration food products and U.S. drugs are classified as category "C" (the risk of use is not excluded). There is insufficient research on the use of digoxin in pregnant women, but the benefit to the mother may justify the risk of its use.

lactation period

Digoxin passes into mother's milk. Since there are no data on the effect of the drug on the newborn during breastfeeding, if therapy is necessary during this period, breastfeeding is recommended to be discontinued.

Application for violations of liver function

Application for violations of kidney function

Use in children

special instructions

All the time of treatment with Digoxin, the patient should be under medical supervision in order to avoid the development of side effects. Patients receiving digitalis preparations should not be given calcium preparations for parenteral administration.

The dose of Digoxin should be reduced in patients with chronic cor pulmonale, coronary insufficiency, violations of water and electrolyte balance, renal or hepatic insufficiency. In elderly patients, careful dose selection is also required, especially if they have one or more of the above conditions. It should be borne in mind that in these patients, even with impaired renal function, the values ​​of creatinine clearance (CC) may be within the normal range, which is associated with a decrease muscle mass and decreased creatinine synthesis. Since pharmacokinetic processes are disturbed in renal failure, dose selection should be carried out under the control of the concentration of digoxin in the blood serum. If this is not feasible, then the following recommendations can be used: in general, the dose should be reduced by approximately the same percentage as the creatinine clearance is reduced. If CC was not determined, then it can be approximately calculated based on the serum creatinine concentration (CC). For men according to the formula (140 - age) / KKS. For women, the result should be multiplied by 0.85. In severe renal failure (CC less than 15 ml / min.), The concentration of digoxin in the blood serum should be determined every 2 weeks, according to at least, in initial period treatment.

With idiopathic subaortic stenosis (obstruction of the outflow tract of the left ventricle, asymmetrically hypertrophied interventricular septum) the appointment of Digoxin leads to an increase in the severity of obstruction.

With severe mitral stenosis and normo- or bradycardia, heart failure develops due to a decrease in diastolic filling of the left ventricle. Digoxin, increasing the contractility of the myocardium of the right ventricle, causes a further increase in pressure in the system pulmonary artery, which can cause pulmonary edema or aggravate left ventricular failure. Patients with mitral stenosis are prescribed cardiac glycosides when right ventricular failure is attached, or in the presence of atrial fibrillation.

In patients with II degree AV blockade, the appointment of cardiac glycosides can aggravate it and lead to the development of a Morgagni-Adams-Stokes attack. The appointment of cardiac glycosides in AV blockade of the 1st degree requires caution, frequent monitoring of the ECG, and in some cases, pharmacological prophylaxis with agents that improve AV conduction.

Digoxin in Wolff-Parkinson-White syndrome, by slowing down AV conduction, promotes the conduction of impulses through additional conduction pathways bypassing the AV node and, thereby, provokes the development of paroxysmal tachycardia.

The likelihood of glycoside intoxication increases with hypokalemia, hypomagnesemia, hypercalcemia, hypernatremia, hypothyroidism, severe dilatation of the heart cavities, "pulmonary" heart, myocarditis and in the elderly. As one of the methods for controlling digitalization in the appointment of cardiac glycosides, monitoring of their plasma concentration is used.

Cross Sensitivity

Allergic reactions to digoxin and other digitalis preparations are rare. If hypersensitivity appears in relation to any one digitalis preparation, other representatives of this group can be used, since cross-sensitivity to digitalis preparations is not characteristic.

The patient must follow the following instructions exactly:

• use the drug only as prescribed, do not change the dose on your own;
• every day to use the drug only at the appointed time;
• if the heart rate is less than 60 beats per minute, you should immediately consult a doctor;
• if the next dose of the drug is missed, it must be taken as soon as possible;
• do not increase or double the dose;
• if the patient has not taken the drug for more than 2 days, this should be reported to the doctor.

Before stopping the use of the drug, it is necessary to inform the doctor about it. If you experience vomiting, nausea, diarrhea, rapid heart rate, you should immediately consult a doctor.

Before surgical intervention or when providing emergency care it is necessary to warn the doctor about the use of Digoxin.

Without the permission of a doctor, the use of other medicines is undesirable. The drug contains sucrose, lactose, potato starch, glucose in an amount corresponding to 0.006 bread units.

Impact on ability to drive vehicles and service other mechanisms

Studies to evaluate the effect of Digoxin on the ability to drive vehicles and maintain mechanisms that require increased concentration attention and speed of psychomotor reactions is not enough, but care should be taken.