lMONITORING REQUIREMENTSMeasurement of corrected
QT interval, and monitoring of ECG and electrolytes
required; correct hypokalaemia, hypomagnesaemia, or
other electrolyte disturbances.
lDIRECTIONS FOR ADMINISTRATIONFor administrationby
mouth, tablets may be crushed and dispersed in water.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Tablet
CAUTIONARY AND ADVISORY LABELS 8
▶Sotalol hydrochloride (Non-proprietary)
Sotalol hydrochloride 40 mgSotalol 40 mg tablets|
28 tabletP£ 1. 53 DT = £ 1. 53
Sotalol hydrochloride 80 mgSotalol 80 mg tablets|
28 tabletP£ 3. 75 DT = £ 1. 08 | 56 tabletP£ 1. 81
Sotalol hydrochloride 160 mgSotalol 160 mg tablets|
28 tabletP£ 6. 25 DT = £ 5. 25
▶Beta-Cardone(Focus Pharmaceuticals Ltd)
Sotalol hydrochloride 200 mgBeta-Cardone 200 mg tablets|
28 tabletP£ 2. 40 DT = £ 2. 40
▶Sotacor(Bristol-Myers Squibb Pharmaceuticals Ltd)
Sotalol hydrochloride 80 mgSotacor 80 mg tablets|
30 tabletP£ 3. 28
CARDIAC GLYCOSIDES
Cardiac glycosides
Digoxin-specific antibody
Serious cases of digoxin toxicity should be discussed with the
National Poisons Information Service (see further
information, under Poisoning, emergency treatment p. 832 ).
Digoxin-specific antibody fragments p. 841 are indicated for
the treatment of known or strongly suspected life-
threatening digoxin toxicity associated with ventricular
arrhythmias or bradyarrhythmias unresponsive to atropine
sulfate p. 810 and when measures beyond the withdrawal of
digoxin below and correction of any electrolyte
abnormalities are considered necessary.
Digoxin
Digoxin is most useful in the treatment of supraventricular
tachycardias, especially for controlling ventricular response
in persistent atrialfibrillation. Digoxin has a limited role in
children with chronic heart failure.
For the management of atrialfibrillation, the maintenance
dose of digoxin is determined on the basis of the ventricular
rate at rest, which should not be allowed to fall below an
acceptable level for the child.
Digoxin is now rarely used for rapid control of heart rate,
even with intravenous administration, response may take
many hours; persistence of tachycardia is therefore not an
indication for exceeding the recommended dose. The
intramuscular route isnotrecommended.
In children with heart failure who are in sinus rhythm, a
loading dose may not be required.
Unwanted effects depend both on the concentration of
digoxin in the plasma and on the sensitivity of the
conducting system or of the myocardium, which is often
increased in heart disease. It can sometimes be difficult to
distinguish between toxic effects and clinical deterioration
because the symptoms of both are similar. The plasma-
digoxin concentration alone cannot indicate toxicity
reliably, but the likelihood of toxicity increases progressively
through the range 1. 5 to 3 micrograms/litre for digoxin.
Renal function is very important in determining digoxin
dosage.
Hypokalaemia predisposes the child to digitalis toxicity
and should be avoided; it is managed by giving a potassium-
sparing diuretic or, if necessary, potassium supplements.
If toxicity occurs, digoxin should be withdrawn; serious
manifestations require urgent specialist management.
Digoxin-specific antibody fragments are available for
reversal of life-threatening overdosage.Digoxin 16-Jun-2017
lDRUG ACTIONDigoxin is a cardiac glycoside that increases
the force of myocardial contraction and reduces
conductivity within the atrioventricular (AV) node.lINDICATIONS AND DOSE
Supraventricular arrhythmias|Chronic heart failure
▶BY MOUTH
▶Neonate (body-weight up to 1.5 kg):Initially
25 micrograms/kg in 3 divided doses for 24 hours, then
4 – 6 micrograms/kg daily in 1 – 2 divided doses.▶Neonate (body-weight 1.5–2.5 kg):Initially
30 micrograms/kg in 3 divided doses for 24 hours, then
4 – 6 micrograms/kg daily in 1 – 2 divided doses.▶Neonate (body-weight 2.6 kg and above):Initially
45 micrograms/kg in 3 divided doses for 24 hours, then
10 micrograms/kg daily in 1 – 2 divided doses.▶Child 1 month–1 year:Initially 45 micrograms/kg in
3 divided doses for 24 hours, then 10 micrograms/kg
daily in 1 – 2 divided doses
▶Child 2–4 years:Initially 35 micrograms/kg in 3 divided
doses for 24 hours, then 10 micrograms/kg daily in
1 – 2 divided doses
▶Child 5–9 years:Initially 25 micrograms/kg in 3 divided
doses (max. per dose 750 micrograms) for 24 hours,
then 6 micrograms/kg daily in 1 – 2 divided doses;
maximum 250 micrograms per day
▶Child 10–17 years:Initially 0. 75 – 1. 5 mg in 3 divided
doses for 24 hours, then 62. 5 – 250 micrograms daily in
1 – 2 divided doses, higher doses may be necessary
▶BY INTRAVENOUS INFUSION
▶Neonate (body-weight up to 1.5 kg):Initially
20 micrograms/kg in 3 divided doses for 24 hours, then
4 – 6 micrograms/kg daily in 1 – 2 divided doses.▶Neonate (body-weight 1.5–2.5 kg):Initially
30 micrograms/kg in 3 divided doses for 24 hours, then
4 – 6 micrograms/kg daily in 1 – 2 divided doses.▶Neonate (body-weight 2.6 kg and above):Initially
35 micrograms/kg in 3 divided doses for 24 hours, then
10 micrograms/kg daily in 1 – 2 divided doses.▶Child 1 month–1 year:Initially 35 micrograms/kg in
3 divided doses for 24 hours, then 10 micrograms/kg
daily in 1 – 2 divided doses
▶Child 2–4 years:Initially 35 micrograms/kg in 3 divided
doses for 24 hours, then 10 micrograms/kg daily in
1 – 2 divided doses
▶Child 5–9 years:Initially 25 micrograms/kg in 3 divided
doses (max. per dose 500 micrograms) for 24 hours,
then 6 micrograms/kg daily in 1 – 2 divided doses;
maximum 250 micrograms per day
▶Child 10–17 years:Initially 0. 5 – 1 mg in 3 divided doses
for 24 hours, then 62. 5 – 250 micrograms daily in
1 – 2 divided doses, higher doses may be necessary
DOSE ADJUSTMENTS DUE TO INTERACTIONS
▶Manufacturer advises reduce dose by half with
concurrent use of amiodarone, dronedarone and
quinine. continued→BNFC 2018 – 2019 Arrhythmias 81
Cardiovascular system2