Download see Section 2.1 - Doncaster and Bassetlaw Hospitals NHS

Doncaster & Bassetlaw Medicines Formulary
Section 2.1: Cardiac Glycosides
Digoxin 62.5, 125 and 250microgram Tablets
Digoxin 50micrograms in 1ml Elixir
Digoxin 100micrograms in 1ml Paediatric Injection
Digoxin 100micrograms in 2ml Injection
Digoxin Specific Antibody Fragment Injection 40mg
(Digifab)
Approved by Drug and Therapeutics Committee: Sept 2014
Review Date: Sept 2017
Prescribing Guidance:
Digoxin is indicated for the control of ventricular rate (>100 beats per minute)
in patients with atrial fibrillation and in the treatment of supraventricular
tachycardia and atrial flutter. Place in therapy for atrial fibrillation and chronic
heart failure has been assessed in NICE clinical guidelines (see below).
The maintenance dose is usually 125 to 250micrograms once daily but varies
depending on renal function, age and indication. The therapeutic range is 1.0
to 2.6nmol/l. Levels at the lower end of the range are generally sufficient for
the inotropic effect in heart failure, whereas the chronotropic effect required in
atrial fibrillation is achieved using levels at the higher end of the range.
Digoxin levels are not routinely required unless sub- or supra-therapeutic
levels are suspected. Blood samples must be taken at least 6 hours post
dose.
Equivalence of Digoxin Preparations:
The bioavailability of digoxin preparations is not identical. Care should be
taken when converting between preparations.
Bioavailability of IV preparation = 1
Bioavailability of liquid = 0.8
Bioavailability of tablets = 0.63
As a general rule:
62.5micrograms (tablet) ≡ 50micrograms (liquid) ≡ 40micrograms (injection)
KEY: [UL] Unlicensed Preparation; Drug – first line choice; Drug – hospital only; Drug –
Amber (TLS), Drug – Red (TLS), see http://medicinesmanagement.doncasterpct.nhs.uk/
NICE guidance (Atrial Fibrillation):
In patients with permanent AF, who need treatment for rate control:


Beta-blockers or rate-limiting calcium antagonists should be the
preferred initial monotherapy in all patients
Digoxin should only be considered as monotherapy in predominantly
sedentary patients
From NICE Clinical Guideline 36 (via www.nice.org.uk/CG36)
Prescribing outside this formulary should only take place via a New Product Request
NICE guidance (Chronic Heart Failure):
Digoxin also has a limited role in heart failure (see below)
From NICE Clinical Guideline 108 (via http://www.nice.org.uk/cg108)
Prescribing outside this formulary should only take place via a New Product Request
Digifab for the Treatment of Life-Threatening Digoxin Toxicity
Prescribing Guidance
Digifab is indicated for the treatment of life-threatening digoxin toxicity
associated with ventricular arrythmias or bradyarrhythmias unresponsive to
atropine where measures beyond withdrawal of digoxin and correction of
serum electrolyte abnormalities are considered necessary.
Prescribing information can be obtained via the National Poisons Information
Service (NPIS) on 08448920111 (there is also a summary of prescribing
information via the NPIS website) or from medicines information via DRI
extension 3317.
Prescribing outside this formulary should only take place via a New Product Request