Digoxin

About Digoxin

Digoxin acts on the sodium-potassium pump in heart muscle, strengthening each contraction, and it increases vagal tone, slowing the heart and conduction through the AV node. It is approved for mild to moderate heart failure in adults, for heart failure in children, and to control the resting heart rate in chronic atrial fibrillation; it does little to slow the heart during exercise. In trials it reduced hospital care for worsening heart failure but did not change survival.

Nausea, vomiting, loss of appetite, confusion, blurred or yellow-green vision and an irregular heartbeat can mean the level is too high. Toxicity is more likely with older age, low body weight, poor kidney function, and low potassium or magnesium or high calcium. It is not used in ventricular fibrillation and needs care in Wolff-Parkinson-White syndrome, sinus node disease or heart block. Long-term use can enlarge breast tissue in men.

Doses are set from lean body weight, age, kidney function and other medicines. Levels are drawn at least 6 hours after a dose, with periodic electrolyte and kidney tests. MedlinePlus advises always taking the same brand.

Taking Digoxin

How to take it

Once a day at the same time, exactly as prescribed; measure the solution with the syringe supplied. Levels are drawn at least 6 hours after a dose, so ask how to time your dose on test days. Do not stop it without your prescriber.

If you miss a dose

Take it as soon as you remember, unless it is nearly time for your next dose; in that case skip the missed dose and carry on as usual. Never take two doses at once to make up.

Storage

At room temperature in a dry, tightly closed container, protected from light and out of reach of children.

Interactions to know about

Amiodarone, dronedarone, quinidine, propafenone, verapamil, diltiazem, clarithromycin and itraconazole raise its levels, so the level is checked and the dose usually lowered first. Antacids, cholestyramine, rifampin and St John’s wort lower them. Potassium-lowering diuretics raise the risk of toxicity, and beta blockers add to its slowing of the heart. Mention digoxin before starting any new medicine or herbal product.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Digoxin differs from pharmacy to pharmacy

Generic tablets cost pharmacies little and appear on some flat-price lists, so the price is mostly the dispensing fee. Lanoxin costs far more, so a prescription that names the brand and blocks substitution, or a pharmacy that stocks only the brand, gives a very different quote.

Not every maker produces the 62.5 mcg tablet, and staying with one manufacturer, as MedlinePlus advises, narrows your choice of pharmacy.

Ways to pay less for Digoxin without insurance

• Ask for generic digoxin, and ask the prescriber to allow substitution unless the brand is clinically needed.
• Ask whether digoxin is on the pharmacy’s flat-price generic list, and for a ninety-day supply once levels are stable.
• Ask a pharmacy that quotes well whether it can keep supplying the same manufacturer.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Digoxin

1. 1.When is my next digoxin level, and how should I time my dose that day?
2. 2.Which symptoms mean my level might be too high?
3. 3.Do any of my medicines or supplements change my level?
4. 4.Should I check my pulse, and what rate should make me call?

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