- See: 
- EKG Changes 
- Interactions and Toxicities: 
- Discussion: 
- for CHF, A.fib, flutter, PAT;

- digitalis is the only drug that slows ventricular response w/o decreasing myocardial contractility; 
* Adult Dosing: 
* Loading: 0.25 - 0.5 PO/IV, then .25mg PO q6hr, until total dose = 1.0-1.5mg;

* Note onset of action = 30min IV, 2hr PO; w/ normal Renal function: 
* Daily dose = 0.125- 0.5mg PO,IV,IM qd; 
* Theraputic Digoxin dose = 0.8 - 2.0 ng/ml; > than 2.4=toxic; 
* Theraputic Digitoxin dose = 13.0 - 25.0 ng/ml; > 40 is toxic; 
- Use in A. Fib 
- onset of IV digoxin takes as long as 30 min. and peaks at 90-120 min

- therefore, digoxin should not be given at intervals less than 2 hrs; 
- some patients may not slow with the initial 0.5 mg IV dose; 
- best indicator of successful of digitalization is ventricular rate; 
- w/ atrial fibrillation, digoxin is given until the rate is controlled to < 120; 
- Precautions: (see interactions) 
- w/ Digoxin Toxicity and Hypo K may try 80 mEq KCl IV may be given in 1 liter of D5W at 6 ml/min (0.5 mEq/min); 
- initial therapy of toxicity related arrhythmias includes LIDOCAINE & dilantin; 
- calcium is contraindicated and Cardioversion should be avoided; 
- Peds: 
- Digitalization: 65-75 ug/kg PO or 50 ug/kg IV; 1/2 total dose initially then 1/4 of total q8-12hr for 2 doses; 
- Maintenance: 15-20 ug/kg/day PO divided q12hr; 2-10 yrs: 
- Digitalization: 30-40 ug/kg PO or 25 ug/kg IV given as above; 
- Maintenance: 8-10 ug/kg/day PO or divided q12hr