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 :764.9

%Protein binding :>90

%Excreted unchanged in urine : 25

Volume of distribution (L/kg) :0.6

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

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Give 50–75% of normal dose

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

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

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

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

CAV/VVHD :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

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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

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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