On the other hand, hypocalcemia can nullify the effects of digoxin in humans; thus, digoxin may be ineffective until serum calcium is restored to normal. Although inactivation of these bacteria by antibiotics is rapid, the serum digoxin concentration will rise at a rate consistent with the elimination half-life of digoxin.
However, available evidence suggests that the incidence and severity of digoxin toxicity has decreased substantially in recent years. However, this drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. The following information includes only the average doses of this medicine. Nevertheless, caution should be exercised when digoxin is administered to a nursing woman.Newborn infants display considerable variability in their tolerance to digoxin. 7Dosierung Die Erhaltungsdosisvon Digoxin beträgt 0,2 - 0,4 mg/Tag.
At randomization, 67% were NYHA class I or II, 71% had heart failure of ischemic etiology, 44% had been receiving digoxin, and most were receiving concomitant ACE inhibitor (94%) and diuretic (82%).
In general, the adverse reactions of digoxin are dose-dependent and occur at doses higher than those needed to achieve a therapeutic effect. The magnitude of rise in serum digoxin concentration relates to the extent of bacterial inactivation, and may be as much as two-fold in some cases.Digoxin is concentrated in tissues and therefore has a large apparent volume of distribution. Patients were randomized to placebo or Digoxin, the dose of which was adjusted for the patient’s age, sex, lean body weight, and serum creatinine (see DOSAGE AND ADMINISTRATION), and followed for up to 58 months (median 37 months). The pharmacologic consequences of these direct and indirect effects are: (1) an increase in the force and velocity of myocardial systolic contraction (positive inotropic action); (2) a decrease in the degree of activation of the sympathetic nervous system and renin-angiotensin system (neurohormonal deactivating effect); and (3) slowing of the heart rate and decreased conduction velocity through the AV node (vagomimetic effect).
Approximately 25% of digoxin in the plasma is bound to protein. On a twice-daily dosing schedule, there will be only minor differences in serum digoxin concentrations whether sampling is done at 8 or 12 hours after a dose.If a discrepancy exists between the reported serum concentration and the observed clinical response, the clinician should consider the following possibilities:The loading dose should be administered in several portions, with roughly half the total given as the first dose.
Wieviel von Digoxin und wie oft sollte Digoxin angewendet werden? Digoxin crosses both the blood-brain barrier and the placenta. Circ Cardiovasc Qual Outcomes. Klicke hier, um einen neuen Artikel im DocCheck Flexikon anzulegen.Freeman JV, Yang J, Sung SH, Hlatky MA, Go AS.
Accessory AV Pathway (Wolff-Parkinson-White Syndrome):Use in Patients with Preserved Left Ventricular Systolic Function:Use in Thyroid Disorders and Hypermetabolic States:Quinidine, verapamil, amiodarone, propafenone, indomethacin, itraconazole, alprazolam,Antacids, kaolin-pectin, sulfasalazine, neomycin, cholestyramine,Treatment of Adverse Reactions Produced by Overdosage:with careful assessment of clinical response before each additional dose.It cannot be overemphasized that both adult and pediatric dosage guidelines provided are based upon average patient response and substantial individual variation can be expected. Although the effect on all-cause death or hospitalization was not statistically significant, much of the apparent benefit derived from effects on mortality and hospitalization attributed to heart failure.In situations where there is no statistically significant benefit of treatment evident from a trial’s primary endpoint, results pertaining to a secondary endpoint should be interpreted cautiously.Digitalis glycosides are contraindicated in patients with ventricular fibrillation or in patients with a known hypersensitivity to digoxin. The Cockcroft and Gault formula for estimation of creatinine clearance includes age, body weight, and gender. If this is not possible, sampling should be done at least 6 to 8 hours after the last dose, regardless of the route of administration or the formulation used.
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