This document provides information about the drug Digoxin, including its pharmacokinetics, mechanism of action, indications, contraindications, adverse effects, drug interactions, dosing, and brand names. Digoxin is a cardiac glycoside that works by inhibiting the sodium-potassium ATPase pump, increasing intracellular sodium and calcium levels. This positively inotropic effect makes it useful for treating congestive heart failure and various arrhythmias. However, it has a narrow therapeutic index and can cause arrhythmias as a side effect. Careful monitoring is needed when using digoxin due to risks of toxicity from drug-drug interactions or electrolyte abnormalities.

1. PATIENT PROFILE & PATIENT COUNSELING
C. DRUG PROFILE OF ATLEAST 25
IMPORTANT MEDICATIONS
DIGOXINE
CLINICAL PHARMACY
BY
Zul Kamal
DEPARTMENT OF PHARMACY
SHAHEED BENAZIR BHUTTO UNIVERSITY, SHERINGAL

2. DIGOXIN
+Ionotropic (Inc. Force of Contractility).
-Chronotropic effects (Dec. HR) Vegal stimulation.
Cardiac Glycosides (Digitalis, Fox Glove).
Cardiac glycosides influence the sodium and calcium ion flows
in the cardiac muscle

4. PHARMACOKINETICS
 ADMINISTERATION
• Orally,
• Parentrally via IV Injection
• METABOLISM
Only 16% is metabolized Liver
 EXCRETION
Most of Digoxine is excreted unchanged in Urine

5. PHARMACODYNAMIC
MECHANISM OF ACTION
 Digoxin inhibit an Enzyme Na/K ATPase. This Enzyme
carries Na to the exterior of the cell and K to the
anterior of the cell.
 There is another system called Ca/Na Exchanger
system. When Na/K ATPase is blocked by digoxin
then there will be excess of Na inside the cell and
increases level of Na is trigger for Ca Influx.
 Thus Ca increases the contractility of heart and thus
pump blood to all parts of the body.

7. INDICATIONS
It is used as
 CHF or CCF
 Atrial Flutter (A condition in which heart rate incraeses
from 240-400 beats i,.e irregular heart beat).
 Atrial Fibrillation (Both are cardiac arrhythmias and can
be diagnosed by the absence of p-waves in ECG).
 Paraoxysmal supraventricular tacchycardias
(Paraoxymal mean that it can occur at regular interval of
time; supraventricular mean that the problem is above
the ventrical i.e SA node)

8. CONTRAINDICATIONS
 Ventricular Tacchycardia
 Ventricular Subaortic stenosis (narrowing of the artery)
 Ventricular Fibrillation

9. ADVERSE EFFECTS
 SA and AV Block
 It can also induce ventricular tacchycardia
NOTE: The common cardiac side effect is arrhythmia, characterized
by slowing of atrioventricular conduction associated with atrial
arrhythmias. A decrease in intracellular potassium is the primary
predisposing factor in these effects.
 CNS: Headache, Fatigue, Delirium, Hallucination.
 Endocrine System: Enlargement of Breast in Female and
Gynecomastia in Male.
 GIT: Nausea, Vomiting and Diarrhea.

10. DRUG INTERACTION
 Diuretics like Thiazide and Loop Diuretics Which
increases the excretion of K and thus incresea the toxicity
of Digoxin; resulting Hypokalemia.
 Calcium Channel Blockers like Verapamil which displaces
Digoxin from its binding site and inc. the level of Digoxin
from 50-75% and thus causing toxicity by ventricular
arrhythmia and heart block.
 Quinidine (Class-I Antiarrhytmic) displace Digoxin from its
binding site which causes Toxicity.

11. DOSE AND DOSAGE FORM
 DOSES
 250-500 µg/day in Two to Three divided doses.
 0.75-1 mg in the form of infusion in EMERGENCY
SITIUATION
 BRAND NAME:
 Lanoxin (GSK), Tabs and Injection
 Digox (Platinum), 250 µgTabs or 0.25 mg
 Doxin (Xenon Pharma), Syrup of 60mL