digitoxin

CLINICAL USE

Heart failure Supraventricular arrhythmias

DOSE IN NORMAL RENAL FUNCTION

Maintenance dose: 100 mcg daily or on alternate days; may be increased to 200 mcg daily if necessary

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :764.9

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :>90

%Excreted unchanged in urine &nbsp &nbsp : 25

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :0.6

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :7.5 days/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : Dose as in normal renal function

10 to 20 &nbsp &nbsp : Dose as in normal renal function

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : Give 50–75% of normal dose

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Not dialysed. Dose as in GFR <10 mL/min

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux &nbsp :Not dialysed. Dose as in GFR <10 mL/min

CAV/VVHD &nbsp &nbsp &nbsp:Not dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsAntifungals: increased toxicity if hypokalaemia occurs with amphotericinDiuretics: increased digitoxin toxicity if hypokalaemia occurs; concentration possibly increased by spironolactone

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

–

Comments

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OTHER INFORMATION

Volume of distribution is decreased by uraemiaLargely metabolised in the liver where 8–10% is converted to digoxin. More digitoxin is converted to digoxin in severe renal impairment

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