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Digoxin, Oral Tablet

Highlights for digoxin

  1. Digoxin oral tablet is available as both a generic and brand-name drug. Brand: Lanoxin
  2. It is also available as an oral solution.
  3. Digoxin is used to treat atrial fibrillation, mild to moderate heart failure in adults, and heart failure in children.
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Important warnings

Important warnings

  • Too high of dose warning: Certain symptoms may indicate that your dose of digoxin is too high. Call your doctor if you experience:
    • nausea
    • vomiting
    • persistent diarrhea
    • confusion
    • weakness
    • loss of appetite
    • abnormal heart rhythm
    • problems with vision
  • Risk of overdose in children warning: If your child is taking digoxin, make sure you’re aware of the symptoms of overdose in children. These include:
    • weight loss
    • failure to thrive
    • stomach pain
    • drowsiness
    • behavioral changes

About

What is digoxin?

Digoxin oral tablet is a prescription drug that’s available as the brand-name drug Lanoxin. It’s also available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand version. It’s also available as an oral solution.

Why it's used

Digoxin is used to treat heart rhythm problems and heart failure. It increases the strength of your heart muscle, normalizes heart rhythm, and helps remove excess water from your body.

How it works

Digoxin belongs to a class of drugs called antiarrhythmics. It works by affecting the sodium pump in your body. Digoxin blocks the sodium pump, which causes sodium to move out of the cells and potassium to move into cells. This affects your heart rhythm, increases your heart strength, and removes excess water from your body.

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Side effects

Digoxin side effects

Digoxin oral tablet does not cause drowsiness. However, it can cause other side effects. Mild side effects may go away within a few days or a couple of weeks. Talk to your doctor or pharmacist if they’re more severe or don’t go away.

More common side effects

The more common side effects that occur with digoxin include:

  • diarrhea
  • dizziness
  • headache

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • allergic reactions. Symptoms may include:
    • skin rash
    • hives
    • itching
    • swelling of your face, lips, or tongue
    • trouble breathing
  • changes in vision, such as blurred vision and vision with a yellow-green tint
  • mental changes, such as:
    • inability to think clearly
    • anxiety
    • depression
    • hallucinations
  • neurological problems. Symptoms may include:
    • confusion
    • changes in behavior
    • feeling lightheaded or faint
    • headache
  • gastrointestinal problems. Symptom may include:
    • nausea or vomiting
    • persistent diarrhea
    • severe stomach pain
  • fast, irregular heart rate
  • unexplained bleeding or bruising
  • unusual weakness or tiredness

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Interactions

Digoxin may interact with other medications

Digoxin oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with promethazine are listed below.

Heart failure drug

  • ivabradine

This drug may lead to toxicity and more side effects, such as bradycardia (a slowed heart rhythm). Your doctor may monitor you closely if you have to take ivabradine with digoxin.

Heart rhythm drugs

  • amiodarone
  • quinidine
  • dofetilide
  • dronedarone
  • propafenone
  • sotalol

These drugs may increase the levels of digoxin in your body or may increase your risk of heart problems. This can lead to toxicity and increased side effects. Your doctor may adjust your dose of digoxin if you have to take certain heart rhythm drugs together with digoxin.

HIV medications

  • ritonavir (Norvir)
  • saquinavir (Invirase)
  • lopinavir/ritonavir (Kaletra)

These medicines increase the level of digoxin in your body. This could result in more side effects or toxicity. Your doctor may lower your dose of digoxin before starting these medications.

Blood pressure drugs

  • captopril
  • carvedilol
  • diltiazem
  • verapamil
  • nifedipine
  • spironolactone
  • telmisartan

These drugs increase the levels of digoxin in your body. Your digoxin levels will be monitored and your dose may be reduced before you start taking these blood pressure medicines.

Antibiotics

  • azithromycin
  • clarithromycin
  • erythromycin
  • gentamicin
  • trimethoprim
  • tetracycline

These medications increase digoxin levels in your body. Your digoxin levels will be monitored and your dose may need to be reduced.

Immune suppressing drug

  • cyclosporine

Cyclosporine increases digoxin levels in your body. Your digoxin levels will be monitored and your dose may need to be reduced.

Cholesterol drug

  • atorvastatin

Atorvastatin increases digoxin levels in your body. Your digoxin levels will be monitored and your dose may need to be reduced.

Antifungal drug

  • itraconazole
  • ketoconazole

These drugs may increase digoxin levels in your body. Your digoxin levels will be monitored and your dose may need to be reduced.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Examples are:

  • indomethacin
  • ibuprofen
  • diclofenac

NSAIDs increase digoxin levels in your body. Your digoxin levels will be monitored and your dose may need to be reduced.

Antidepressant

  • nefazodone

Nefazodone increases digoxin levels in your body. Your digoxin levels will be monitored and your dose may need to be reduced.

Propantheline

Propantheline increases digoxin levels in your body. Your digoxin levels will be monitored and your dose may need to be reduced.

Antimalarial

  • quinine

Quinine increases digoxin levels in your body. Your digoxin levels will be monitored and your dose may need to be reduced.

Chest pain drug

  • ranolazine

Ranolazine increases digoxin levels in your body. Your digoxin levels will be monitored and your dose may need to be reduced.

Stimulant drugs

Examples are:

  • epinephrine
  • norepinephrine
  • phenylephrine
  • domamine

If you take these medications with digoxin, it can lead to irregular heart rhythm.

Succinylcholine

Taking succinylcholine with digoxin it can lead to irregular heart rhythm.

Low sodium level drug

  • tolvaptan
  • conivaptan

These drugs may increase digoxin levels in your body. Your digoxin levels will be monitored and your dose may need to be reduced.

Cancer drug

  • lapatinib

This drug may increase the levels of digoxin in your body. Your doctor may adjust your dosage of digoxin if you have to take these drugs together.

Proton pump inhibitors

  • rabeprazole
  • esomeprazole
  • lansoprazole
  • omeprazole

These drugs may increase the levels of digoxin in your body. Your doctor may adjust your dosage of digoxin if you have to take these drugs together.

Antiplatelet drug

  • ticagrelor

This drug may increase the levels of digoxin in your body. Your doctor may adjust your dosage of digoxin if you have to take these drugs together.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

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Other warnings

Digoxin warnings

Digoxin oral tablet comes with several warnings.

Allergy warning

This drug may cause a severe allergic reaction. Symptoms may include:

  • skin rash
  • hives
  • itching
  • swelling of your face, lips, or tongue
  • trouble breathing

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal.

Warnings for people with certain health conditions

For people with ventricular fibrillation: Digoxin can’t be used if you have ventricular fibrillation. It may make your ventricular fibrillation worse.

For people with Wolff-Parkinson-White syndrome: If you have Wolff-Parkinson-White syndrome, you’re at a higher risk for an abnormal heart rhythm. Digoxin may increase your risk even further.

For people with sinus node disease and AV block: Digoxin can cause severe low heart rate and complete heart block if you have sinus node disease. You should get a pacemaker before starting digoxin if you have sinus node disease or heart block.

For people with preserved left ventricular systolic function: If you have this type of heart failure you should not use digoxin. It may increase your risk of side effects, such as chest pain and shortness of breath.

For people with a risk of ventricular arrhythmias during electrical cardioversion: If you’re going to receive electrical cardioversion, your dose of digoxin may be reduced or you may be taken off of the medication 1–2 days before your procedure. This is done to prevent heart rhythm problems.

For people with a heart attack: Digoxin isn’t recommended for people having a heart attack. Using this drug can restrict blood flow to the heart.

For people with myocarditis: You shouldn’t use digoxin if you have myocarditis. It can narrow your blood vessels and cause inflammation.

For people with kidney disease: Digoxin is cleared from your body by your kidneys. If your kidneys don’t work as well, the drug may build up and cause toxicity. Your dose should be lower than normal if you have kidney problems.

For people with thyroid disorders: If you have hypothyroidism you might be more sensitive to digoxin. Because of this, your dose of digoxin may need to be reduced.

For people with electrolyte imbalances: If you have low levels of potassium, digoxin may be more active in your body, increasing the risk for toxicity. If you have low levels of magnesium, your heart may be more sensitive to changes in heart rhythm due to digoxin. If you have low calcium levels, digoxin may not work as well. You may be more likely to get digoxin toxicity, even at normal digoxin levels, if you have any of these electrolyte imbalances.

Warnings for other groups

For pregnant women: Digoxin is a category C pregnancy drug. That means there haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Tell your doctor if you’re pregnant or plan to become pregnant. Digoxin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

For women who are breastfeeding: Studies have shown that digoxin passes through breast milk. It’s unknown if this causes any effects in a breastfeeding child. You and your doctor may need to decide if you’ll take digoxin or breastfeed.

For Seniors: Seniors may need smaller doses of digoxin and may be monitored more closely. Adults over 65 years old are more likely to have kidney problems, which may lead to greater drug side effects.

For Children: The safety and effectiveness of digoxin in people under 18 years hasn’t been established. But the drug may be used to treat heart failure in children.

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Dosage

How to take digoxin

This dosage information is for digoxin oral tablet. All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Forms and strengths

Generic: Digoxin

  • Form: Oral tablet
  • Strengths: 62.5 mcg, 125 mcg, 187.5 mcg, and 250 mcg

Brand: Lanoxin

  • Form: Oral tablet
  • Strengths: 125 mcg and 250 mcg 

Dosage for mild to moderate heart failure in adults

Adult Dosage (ages 18 years and older)

  • Loading Dose: The total dose is 10–15 mcg per kilogram (kg) of bodyweight divided and taken 3 times per day.
  • You should take half of the loading dose first, and then take half of the remaining dose 6–8 hours later. Take the rest of the dose 6–8 hours after that.
  • Maintenance Dose: The maintenance dose is individualized. It’s based on weight, age, kidney function, current medical conditions, and other medications.
  • The maintenance dose is taken once per day.

Special Considerations

Kidney disease: Digoxin is cleared from your body by your kidneys. If you have kidney disease, your dose of digoxin will be lower.

Thyroid disorders: If you have hypothyroidism, you might be more sensitive to digoxin. Because of this, your dose of digoxin may need to be reduced.

Dosage for atrial fibrillation in adults

Adult Dosage (ages 18 years and older)

  • Loading Dose: The total dose is 10–15 mcg per kilogram (kg) of bodyweight divided and taken 3 times per day.
  • You should take half of the loading dose first, and then take half of the remaining dose 6–8 hours later. Take the rest of the dose 6–8 hours after that.
  • Maintenance Dose: The maintenance dose is individualized. It’s based on weight, age, kidney function, current medical conditions, and other medications.
  • The maintenance dose is taken once per day.

Special Considerations

Kidney disease: Digoxin is cleared from your body by your kidneys. If you have kidney disease, your dose of digoxin will be lower.

Thyroid disorders: If you have hypothyroidism, you might be more sensitive to digoxin. Because of this, your dose of digoxin may need to be reduced.

Dosage for heart failure in children

Child Dosage (ages 11-17 years)

  • Loading Dose: The total dose is 10–15 mcg per kilogram (kg) of bodyweight divided and taken 3 times per day.
  • You should take half of the loading dose first, and then take half of the remaining dose 6–8 hours later. Take the rest of the dose 6–8 hours after that.
  • Maintenance Dose: The maintenance dose is individualized. It’s based on weight, age, kidney function, current medical conditions, and other medications.
  • The maintenance dose is taken once per day.

Child Dosage (ages 5-10 years)

  • Loading Dose: The total dose is 20–45 mcg/kg divided and taken 3 times per day.
  • You should take half of the loading dose first, and then take half of the remaining dose 6–8 hours later. Take the rest of the dose 6–8 hours after that.
  • Maintenance Dose: The maintenance dose is individualized. It’s based on weight, age, kidney function, current medical conditions, and other medications.
  • The maintenance dose is taken two times per day.

Child Dosage (ages 0-4 years)

A safe and effective dose hasn’t been established for this age group.

Special Considerations

Kidney disease: Digoxin is cleared from your body by your kidneys. If you have kidney disease, your dose of digoxin will be lower.

Thyroid disorders: If you have hypothyroidism, you might be more sensitive to digoxin. Because of this, your dose of digoxin may need to be reduced.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.

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Take as directed

Take as directed

Digoxin oral tablet is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed.

if you don’t take it at all: If you don’t take it at all, your condition may get worse, which can lead to hospitalization or even death.

if you skip or miss doses: If you miss doses or don’t take it on schedule, the amount of medication in your body fluctuates. This can cause symptoms of your condition to get worse.

if you take too much: If you think you’ve taken too much, go to the emergency room or contact the poison control center. Signs of overdose with digoxin in adults and children include:

  • nausea
  • vomiting
  • loss of appetite
  • fatigue
  • irregular heart rate
  • dizziness
  • vision problems

Other signs of overdose in children and infants include:

  • failure to thrive
  • behavioral changes, such as hallucinations and psychotic episodes
  • weight loss
  • stomach pain
  • drowsiness

if you miss a dose: If you miss a dose, take it as soon as you remember. If it’s close to the time of your next dose, take only one dose at that time.

Don’t double a dose to try to make up for missed doses before speaking to your doctor or pharmacist.

how to tell the drug is working: You may be able to tell this drug is working if your heart rate returns to normal or your symptoms get better.

Important considerations

Important considerations for taking digoxin

Keep these considerations in mind if your doctor prescribes digoxin oral tablets for you.

General

  • You don’t have to take digoxin with food.
  • You can crush or cut a digoxin tablet.

Storage

  • Store digoxin tablets at room temperature 68–77°F (20–25°C). Store it in its original container to protect it from light.
  • Keep the container tightly closed.
  • Keep it away from areas where it could get wet, such as bathrooms and damp locations.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry it with you in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt this medication.
  • You may need to show your pharmacy’s preprinted label to clearly identify the medication. Keep the original prescription label with you when traveling.

Clinical monitoring

While you are taking digoxin, your doctor will check the following:

  • electrolyte levels
  • kidney function
  • levels of digoxin to make sure that they are still safe for you
  • blood pressure and heart rate. You should also check your blood pressure and heart rate each day.

Insurance

Many insurance companies will require a prior authorization before they approve the prescription and pay for digoxin.

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Alternatives

Are there any alternatives?

There are several medications in this class that can be used to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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