DOSE EQUIVALENCE AND CONVERSION
▶Dose may need to be reduced if digoxin (or another
cardiac glycoside) has been given in the preceding
2 weeks.
▶When switching from intravenous to oral route may
need to increase dose by 20 – 33 % to maintain the same
plasma-digoxin concentration.lUNLICENSED USEDigoxin is licensed for use in heart
failure and supraventricular arrhythmias.
lCONTRA-INDICATIONSConstrictive pericarditis (unless to
control atrialfibrillation or improve systolic dysfunction—
but use with caution).hypertrophic cardiomyopathy
(unless concomitant atrialfibrillation and heart failure—
but use with caution).intermittent complete heart block.
myocarditis.second degree AV block.supraventricular
arrhythmias associated with accessory conducting
pathways e.g. Wolff-Parkinson-White syndrome (although
can be used in infancy).ventricular tachycardia or
fibrillation
lCAUTIONSAvoid hypercalcaemia (risk of digitalis toxicity)
.avoid hypokalaemia (risk of digitalis toxicity).avoid
hypomagnesaemia (risk of digitalis toxicity).avoid
hypoxia (risk of digitalis toxicity).severe respiratory
disease.sick sinus syndrome.thyroid disease
lINTERACTIONS→Appendix 1 : digoxin
lSIDE-EFFECTS
▶Common or very commonArrhythmias.cardiac conduction
disorder.cerebral impairment.diarrhoea.dizziness.
eosinophilia.nausea.skin reactions.vision disorders.
vomiting
▶UncommonDepression
▶Rare or very rareAppetite decreased.asthenia.confusion
.gastrointestinal disorders.gynaecomastia.headache.
malaise.psychosis.thrombocytopenia
OverdoseIf toxicity occurs, digoxin should be withdrawn;
serious manifestations require urgent specialist
management.
lPREGNANCY
Dose adjustmentsMay need dosage adjustment.
lBREAST FEEDINGAmount too small to be harmful.
lRENAL IMPAIRMENT
Dose adjustmentsUse half normal dose if estimated
glomerularfiltration rate is 10 – 50 mL/minute/ 1. 73 m^2 and
use a quarter normal dose if estimated glomerular
filtration rate is less than 10 mL/minute/ 1. 73 m^2.
MonitoringMonitor plasma-digoxin concentration in renal
impairment.
lMONITORING REQUIREMENTS
▶For plasma-digoxin concentration assay, blood should be
taken at least 6 hours after a dose.
▶Plasma-digoxin concentration should be maintained in the
range 0. 8 – 2 micrograms/litre.
▶Monitor serum electrolytes and renal function. Toxicity
increased by electrolyte disturbances.
lDIRECTIONS FOR ADMINISTRATION
▶With intravenous useAvoid rapid intravenous
administration (risk of hypertension and reduced coronary
flow). Forintravenous infusion, dilute with Sodium Chloride
0. 9 % or Glucose 5 % to a max. concentration of
62. 5 micrograms/mL; loading doses should be given over
30 – 60 minutes and maintenance dose over
10 – 20 minutes.
▶With oral useFororaladministration, oral solution must
notbe diluted.
lPATIENT AND CARER ADVICEPatient counselling is advised
for digoxin elixir (use pipette).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, solution
for injection
Tablet
▶Digoxin (Non-proprietary)
Digoxin 62.5 microgramDigoxin 62. 5 microgram tablets|
28 tabletP£ 9. 99 DT = £ 1. 23
Digoxin 125 microgramDigoxin 125 microgram tablets|
28 tabletP£ 4. 99 DT = £ 1. 22
Digoxin 250 microgramDigoxin 250 microgram tablets|
28 tabletP£ 4. 99 DT = £ 1. 22
▶Lanoxin(Aspen Pharma Trading Ltd)
Digoxin 62.5 microgramLanoxin PG 62. 5 microgram tablets|
500 tabletP£ 8. 09
Digoxin 125 microgramLanoxin 125 tablets| 500 tabletP
£ 8. 09
Digoxin 250 microgramLanoxin 250 microgram tablets|
500 tabletP£ 8. 09
Solution for injection
EXCIPIENTS:May contain Alcohol, propylene glycol
▶Lanoxin (Imported (United States))
Digoxin 100 microgram per 1 mlLanoxin Injection Pediatric
100 micrograms/ 1 ml solution for injection ampoules|
10 ampoulePs
Solution for infusion
▶Digoxin (Non-proprietary)
Digoxin 250 microgram per 1 mlDigoxin 500 micrograms/ 2 ml
solution for infusion ampoules| 10 ampouleP£ 7. 00
▶Lanoxin(Aspen Pharma Trading Ltd)
Digoxin 250 microgram per 1 mlLanoxin 500 micrograms/ 2 ml
solution for infusion ampoules| 5 ampouleP£ 3. 30
Oral solution
▶Lanoxin(Aspen Pharma Trading Ltd)
Digoxin 50 microgram per 1 mlLanoxin PG 50 micrograms/ml elixir
| 60 mlP£ 5. 35 DT = £ 5. 352 Bleeding disorders
Antifibrinolytic drugs and
haemostatics
Overview
Fibrin dissolution can be impaired by the administration of
tranexamic acid below, which inhibitsfibrinolysis. It can be
used to prevent bleeding or treat bleeding associated with
excessivefibrinolysis (e.g. in surgery, dental extraction,
obstetric disorders, and traumatic hyphaema) and in the
management of menorrhagia; it may also be used in
hereditary angioedema, epistaxis, and thrombolytic
overdose. Tranexamic acid can also be used in cardiac
surgery to reduce blood loss and to reduce the need for use of
blood products.
Desmopressin p. 432 is used in the management of mild to
moderate haemophilia and von Willebrand’s disease. It is
also used forfibrinolytic response testing.ANTIHAEMORRHAGICS›ANTIFIBRINOLYTICS
Tranexamic acid 26-Apr-2017
lINDICATIONS AND DOSE
Inhibition of fibrinolysis
▶BY MOUTH
▶Child: 15 – 25 mg/kg 2 – 3 times a day (max. per dose
1. 5 g)
▶BY SLOW INTRAVENOUS INJECTION
▶Child: 10 mg/kg 2 – 3 times a day (max. per dose 1 g),
dose to be given over at least 10 minutes82 Bleeding disorders BNFC 2018 – 2019
Cardiovascular system2