Digoxin
When ATH:
C01AA05
Characteristic.
Glycoside leaves woolly foxglove. The white crystalline powder. It is soluble in water, practically insoluble in alcohol.
Pharmacological action.
Kardiostimuliruyuschy, antiarrhythmic.
Application.
Congestive heart failure (without hemodynamically significant obstruction outflow tract of the heart), atrial tachyarrhythmia, supraventricular paroxysmal tachycardia, auricular flutter.
Contraindications.
Hypersensitivity, glikozidnaya intoxication.
Restrictions apply.
Acute coronary insufficiency, active myocarditis, cardiac tamponade, constrictive pericarditis, vыrazhennaya bradycardia, AV блокада I–II степени, unstable angina, arrythmia, ventricular tachycardia.
Pregnancy and breast-feeding.
Category actions result in FDA - C. (The study of reproduction in animals has revealed adverse effects on the fetus, and adequate and well-controlled studies in pregnant women have not held, However, the potential benefits, associated with drugs in pregnant, may justify its use, in spite of the possible risk.)
Side effects.
Nausea, vomiting, anorexia, bradycardia, ventricular premature beats, OF блокада, headache, dizziness. May impair color vision, reduced visual acuity, scotoma, Macro- and mikroopsiya, at long application - gynecomastia.
Cooperation.
Agonists increase the likelihood of arrhythmia, antiarrhythmic and anticholinesterase drugs - bradycardia, glucocorticoids, saluretics etc.. funds, contributing to the loss of potassium, calcium supplements - glycoside intoxication. Chlorpromazine reduces cardiotonic effect, laxatives, antacids, funds, aluminum-containing, vysmut, magnesium, - Absorption. Rifampicin accelerates metabolism.
Overdose.
Symptoms: OF блокада, vomiting, nausea, arrhythmia.
Treatment: potassium supplements, dimercaprol, EDTA.
Dosing and Administration.
Inside, I / bolus or infusion. Inside administered on the first day at regular intervals - for 0,25 mg 4-5 times a day, the following days - for 0,25 mg 3 once a day, then move on to maintenance doses - 0,5-0,25-0,125 mg / day. B / - in a dose of 0.25-0.5 mg.
Precautions.
In patients with renal insufficiency requires a dose reduction.
Cooperation
| Active substance | Description of interaction |
| Azithromycin | FKV. FMR. It increases absorption and provokes effects of overdose, especially in patients, which collapses digoxin intestinal bacterial flora. |
| Activated carbon | Reduces bioavailability. |
| Algeldrat + Magnesium hydroxide | FKV. Slows absorption (the interval between doses should be at least 2 no). |
| Aminosalicylic acid | FKV. Slightly reduces the bioavailability in the blood and (It is shown in healthy volunteers). |
| Amiodarone | FKV. Slows biotransformation (reduces the activity of CYP450) and may increase (on 70%) concentration in the blood, causing symptoms of overdose. |
| Amlodipine | FMR: synergism. Strengthens (mutually) deterioration of AV conduction. |
| Amphotericin B | FMR. It promotes the development of hypokalemia and hypomagnesemia, and increase the likelihood of glycoside intoxication. |
| Atenolol | FMR: synergism. Strengthens (mutually) inhibition of AV conduction. |
| Betaksolol | FMR: synergism. Strengthens (mutually) inhibition of AV conduction. |
| Betametazon | FMR: synergism. It increases the likelihood of intoxication: hypokalemia and hypomagnesemia, as well as reducing the content of potassium and magnesium in the myocardium increases its sensitivity. |
| Bisoprolol | FMR: synergism. Strengthens (mutually) inhibition of AV conduction. |
| Bumetanid | FMR. By promoting the excretion of potassium, It increases the likelihood of glycoside intoxication. |
| Gidrokortizon | FMR. It increases the likelihood of intoxication: hypokalemia and hypomagnesemia, as well as reducing the content of potassium and magnesium in the myocardium increases its sensitivity. |
| Gidroxlorotiazid + Captopril | FKV. Increase the concentration in the blood (15-20%). |
| Diltiazem | FMR: synergism. Enhances oppression AV conduction. |
| Levothyroxine sodium | FMR. Weakens effect; combined use may require increased doses. |
| Liotironin | FMR. Weakens effect; combined administration can lead to the need to increase the dose. |
| Magnesium oxide | FKV. Prevents absorption, lowers blood concentration and effect weakens. |
| Methyldopa | FMR: synergism. It increases the likelihood of developing (in elderly) sick sinus syndrome. |
| Metoclopramide | Reduces the absorption and bioavailability, the combined appointment may need to increase the dose. |
| Metoprolol | FMR: synergism. Strengthens (mutually) inhibition of AV conduction. |
| Nadolol | FMR: synergism. Strengthens (mutually) inhibition of AV conduction. |
| Natriya carbonate | FKV. Prevents absorption, lowers blood concentration and effect weakens. |
| Neomycin | FKV. Assign inside, impedes absorption in the gastrointestinal tract and significantly lowers the blood concentration. |
| Neostigmine | FKV. It accelerates the promotion of content in the digestive tract and reduces the bioavailability. |
| Nimodipine | FMR: synergism. Strengthens (mutually) deterioration of AV conduction. |
| Nifedipine | FKV. FMR: synergism. Strengthens (mutually) deterioration of AV conduction, reduced renal clearance and increases in blood. |
| Norepinephrine | FMR. It increases the risk of arrhythmias. |
| Oxytetracycline | FKV. It increases the probability of absorption and toxicity, especially in patients, which collapses digoxin intestinal bacterial flora. |
| Pindolol | FMR: synergism. Strengthens (mutually) inhibition of AV conduction. |
| Propafenone | Increases plasma concentration (of 35-85%), reduces the volume of distribution and clearance, increasing the risk of intoxication; with a joint appointment is recommended that monitoring of digoxin concentrations, if necessary, reduction ego doz. |
| Propranolol | FMR: synergism. Strengthens (mutually) inhibition of AV conduction. |
| Rifamiцin | FKV. Accelerates biotransformation and weakens the effect. |
| Rifampicin | FKV. Accelerates biotransformation, increases clearance, It reduces the concentration of the blood and weakens the effect. |
| Sertraline | FKV. Displace from its association with proteins, increasing the plasma levels of free fraction. |
| Sotalol | FMR: synergism. Strengthens (mutually) inhibition of AV conduction. |
| Spironolactone | Increases plasma levels, T1/2 and the risk of toxicity (with a joint appointment is necessary to reduce the dose or increase the interval between doses). |
| Sucralfate | FKV. Reduces absorption and bioavailability; the interval between doses should be at least 2 no. |
| Telmisartan | FKV. Increases Withmax and Cmin; the combined appointment necessary monitoring of digoxin in the blood. |
| Tetracycline | FKV. It increases the probability of absorption and toxicity, especially in patients, which collapses digoxin intestinal bacterial flora. |
| Ticlopidine | FKV. Decreases (insignificantly) level in plasma. |
| Timolol | FMR: synergism. Strengthens (mutually) inhibition of AV conduction. |
| Topiramate | FKV. Slightly reduces the AUC. |
| Trazodone | FKV. Increases concentration of plasma. |
| Felodipine | FMR: synergism. Strengthens (mutually) inhibition of AV conduction. |
| Phenylbutazone | Reduces effect. |
| Phenytoin | FMR. Reduces effect. |
| Furosemid | FMR: synergism. By promoting the excretion of potassium, It increases the risk of glycoside intoxication. |
| Quinidine | FKV. Increases concentration in the blood (consequently reducing the secretion of competitive renal proximal tubule). |
| Chlorpromazine | FMR: antagonizm. Reduces effect. |
| Epinephrine | FMR. It increases the risk of arrhythmias. |
| Erythromycin | FKV. FMR. Increases absorption, Increases in serum, enhances the effects and toxicity, especially in patients, which collapses digoxin intestinal bacterial flora. |
| Esmolol | FKV. FMR. Strengthens (mutually) inhibition of AV conduction; increases (insignificantly) level in plasma. |
| Ephedrine | FMR. It increases the risk of arrhythmias. |
