General Toxicity Notes
Add to uremic gastrointestinal symptoms. Toxicity enhanced by hypokalemia and hypomagnesemia during dialysis.
Excreted Unchanged %
76-85
Half-Life (Normalesrd) Hours
36-44/80-120
Plasma Protein Binding %
20-30
Volume Of Distribution L/Kg
5-8
Dose For Normal Renal Function
1.0-1.5 mg load, then 0.25-0.5 mg q24h
Adjustment For Renal Failure Method
D, I
Adjustment For Renal Failure Gfr, Ml/Min >50 [Recommended Level]
100% q24h [A]
Adjustment For Renal Failure Gfr, Ml/Min 10-50 [Recommended Level]
25-75% q36h [A]
Adjustment For Renal Failure Gfr, Ml/Min <10 [Recommended Level]
10-25% q48h [A]
Supplement For Dialysis [Recommendation Level]: Ihd
IHD: None
Supplement For Dialysis [Recommendation Level]: Pd
PD: None
Supplement For Dialysis [Recommendation Level]: Crrt
CRRT: Dose for GFR 10-50,monitor serum concentration, [D]
References
Sonnenblick M, Abraham AS, Meshulam Z, Eylath U. Correlation between manifestations of digoxin toxicity and serum digoxin, calcium, potassium, and magnesium concentrations and arterial pH. Br Med J (Clin Res Ed). 1983; 286: 1089-91. [PMID: 6404339]
Toxicity Notes
Decrease loading dose by 50% in ESRD. Radioimmunoassay may overestimate serum levels in uremia. Clearance decreased by amiodarone, spironolactone, quinidine, verapamil. Hypokalemia, hypomagnesemia enhance toxicity. Vd and total body clearance decreased in ESRD. Serum level after 12 dose hours is best guide in ESRD. Digoxin immune antibodies can treat severe toxicity in ESRD.