Digoxin is a cardiac glycoside primarily used to treat heart failure and certain arrhythmias. It enhances myocardial contractility, reduces myocardial oxygen consumption, and improves cardiac pumping function. This medication is commonly prescribed for chronic heart failure to alleviate symptoms such as dyspnea and edema, and it can also regulate heart rate in atrial fibrillation or sinus tachycardia.
The therapeutic window of digoxin is narrow, requiring regular monitoring of blood levels to prevent toxicity. Its mechanism of action involves inhibiting sodium-potassium ATPase, leading to increased intracellular calcium ions, which in turn enhances cardiac contractility. Clinical use must consider renal function, as the drug is primarily excreted via the kidneys.
The generic name of digoxin is Digoxin. Common brand names include:
Different pharmaceutical companies may have other trade names, but the active ingredient remains digoxin.
Digoxin belongs to the Cardiac Glycosides class of drugs, characterized by both cardiovascular and electrophysiological effects. Its features include:
This classification grants it unique efficacy in treating specific arrhythmias.
Main indications include:
In acute heart failure episodes, other medications are usually preferred; digoxin is mainly used for long-term stable treatment.
This drug is particularly effective in patients with normal left ventricular systolic function but significant cardiac dilation, but it is less effective when systolic function is severely impaired (LVEF < 40%).
Mild side effects include:
These symptoms are usually related to dosage or elevated blood levels and should be reported to a physician for dose adjustment.
Serious side effects may include:
If these symptoms occur, discontinue medication immediately and seek medical attention.
Contraindicated groups include:
These contraindications must be ruled out before use.
Pregnancy Category C, use only when benefits outweigh risks. Avoid during breastfeeding, as the drug may be secreted into breast milk. Patients over 65 should pay special attention to renal function due to age-related decline in metabolism.
Concurrent use with the following drugs may increase toxicity risk:
Blood levels of digoxin should be monitored when used together.
When combined with amiodarone or β-blockers, close ECG monitoring is necessary to avoid conduction block. Combining with calcium channel blockers may increase the risk of hypokalemia; electrolytes should be regularly checked.
Oral formulations are usually taken once daily or divided doses. The initial dose is adjusted based on body weight and renal function, with common starting doses of 0.125-0.25 mg/day for adults. Intravenous injection is reserved for emergency situations and should be administered slowly under medical supervision.
Consistent timing is important to maintain stable blood levels, preferably taken after meals to reduce gastrointestinal discomfort. Therapeutic effects may take 5-7 days; chronic heart failure treatment requires continuous use to maintain efficacy.
If a dose is missed within 6 hours of the scheduled time, take it immediately and adjust the next dose accordingly; if more than 6 hours have passed, skip the missed dose and resume normal schedule the next day. Do not double the dose.
If multiple doses are missed and symptoms worsen (e.g., increased dyspnea), seek medical evaluation immediately to consider treatment adjustments. Establishing medication reminders and fixed dosing times can effectively reduce missed doses.
Signs of toxicity include visual disturbances, bradycardia or arrhythmias, nausea, and vomiting. Suspected overdose requires immediate medical attention, possibly with the use of digoxin-specific antibody (Digibind) for detoxification.
Emergency measures include:
Do not induce vomiting at home; contact Poison Center or emergency room immediately.
FAQs about Digoxin
地高辛的服用時間是否需要配合餐點？
建議在固定時間服用地高辛以維持血中濃度穩定，但餐前或餐後服用皆可。若服用後出現胃部不適，可嘗試與餐點同服以緩解症狀。重要的是每日固定時間服用，並避免忘記或重複服用。
服用地高辛期間出現噁心或嘔吐，該如何應對？
輕微噁心可能因胃腸道刺激引起，可嘗試分次服用或與食物一起服用緩解。若症狀持續或嚴重，應立即停藥並聯絡醫師，可能需要調整劑量或評估是否出現中毒現象。
地高辛與其他藥物（如抗生素或降血壓藥）合併使用需注意什麼？
地高辛可能與某些抗生素（如大環內酯類）、抗心律不整藥或利尿劑產生交互作用，影響藥效或增加毒性風險。使用其他藥物前應主動告知醫護人員正在服用地高辛，並定期進行血藥濃度監測。
服用地高辛期間是否需要限制特定飲食或運動？
應避免過量攝取高鉀食物（如香蕉、 avocado、菠菜），因高血鉀可能加劇地高辛的副作用。運動方面建議選擇中等強度活動，若運動後出現心悸或胸悶，應立即停止並諮詢醫師。
如果錯過一次服藥時間，該如何處理？
若漏服時間接近下次服藥時間（如少於6小時），請跳過漏服次數並按時服用下一次劑量，切勿加倍服用。若漏服時間較長，請依實際情況與醫護人員確認補救措施，避免血藥濃度波動影響治療效果。
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