Medication Card – Digoxin (Lanoxin®) (Kor/Eng)

 

 

Classification (분류)

• Therapeutic (치료적 분류): Antiarrhythmic, Inotropic agent (항부정맥제, 강심제)
• Pharmacologic (약리학적 분류): Cardiac glycoside (강심배당체)

 

 

 

Indications (적응증)

• Heart failure (심부전)
• Atrial fibrillation & atrial flutter (심방세동 및 심방조동)
• Supraventricular tachycardia (상심실성 빈맥)

 

 

 

 

Therapeutic Effects (치료 효과)

• Increases force of myocardial contraction (심근 수축력 증가 → 심박출량 증가)
• Slows heart rate by decreasing conduction through the AV node (심박수 감소, AV결절 전도 억제)

 

 

 

 

Absorption (흡수)

• Oral: 60–80% absorbed (경구: 60–80% 흡수)

 

 

 

 

Distribution (분포)

• Widely distributed in body tissues, especially heart, liver, kidneys, skeletal muscle (심장, 간, 신장, 골격근에 광범위 분포)

 

 

 

 

Protein Binding (단백결합)

• About 20–30% bound (약 20–30% 단백결합)

 

 

 

 

Metabolism & Excretion (대사 및 배설)

• Minimal hepatic metabolism (간에서 거의 대사되지 않음)
• Mostly excreted unchanged by kidneys (주로 신장에서 대사되지 않고 배설)

 

 

 

 

Onset/Peak/Duration (작용발현/최고효과/지속시간)

• Oral (PO): Onset 30–120 min / Peak 2–6 hr / Duration 2–4 days
• IV: Onset 5–30 min / Peak 1–5 hr / Duration 2–4 days

 

 

 

 

Adverse Effects (부작용, ADEs)

• Cardiac (심장): Bradycardia, AV block, arrhythmias (서맥, 방실차단, 부정맥)
• GI (소화기): Anorexia, nausea, vomiting, diarrhea (식욕부진, 구역, 구토, 설사)
• CNS (중추신경): Headache, confusion, visual disturbances (especially yellow/green halos) (두통, 혼돈, 시각장애–노란/초록빛 후광)

 

 

 

 

 

Drug Interactions (약물 상호작용)

• ↑ Toxicity risk: Diuretics causing hypokalemia (loop & thiazide diuretics), Amiodarone, Quinidine, Verapamil (저칼륨혈증 유발 이뇨제, 아미오다론, 퀴니딘, 베라파밀 → 독성 ↑)
• ↓ Effect: Antacids, St. John’s Wort (제산제, 세인트존스워트 → 효과 감소)

 

 

 

 

Dose (용량)

• Adult PO: Loading dose 0.75–1.25 mg (divided), then maintenance 0.125–0.5 mg/day
• IV: 0.25–0.5 mg initially, then 0.1–0.25 mg q6h as needed
  (정확한 용량은 환자 나이, 체중, 신장기능에 따라 조정)

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Nursing Interventions (간호중재)

• Always check apical pulse for 1 full minute before administration; hold if HR < 60 bpm (투여 전 심첨맥박 1분 측정, 60회 이하 시 투여 보류)
• Monitor ECG for arrhythmias (심전도 모니터링)
• Monitor serum digoxin level (0.5–2.0 ng/mL = therapeutic range) (치료농도 확인)
• Assess electrolytes (especially potassium, magnesium, calcium) (전해질 검사: K, Mg, Ca)
• Monitor renal function (신기능 검사)

 

 

 

 

Patient Teaching (환자 교육)

• Take medication at the same time every day (매일 같은 시간에 복용)
• Do not double dose if missed (빠뜨렸을 때 두 배 복용 금지)
• Teach patient/family to check pulse before taking; report HR < 60 bpm (투여 전 맥박 측정, 60회 미만 시 보고)
• Report symptoms of toxicity: nausea, vomiting, anorexia, vision changes, palpitations (독성 증상–식욕부진, 구토, 시야흐림, 심계항진–즉시 보고)
• Avoid OTC medications/herbals without consulting provider (임의로 일반의약품/한약 복용 금지)

 

 

 

 

 

 

Digoxin(Lanoxin®)

antiarrhythmics, inotropics /Cardiac glycoside

● Indications: HF, Atrial fibrillation and atrial flutter (slows ventricular rate). Paroxysmal atrial tachycardia.

● Therapeutic effects: Increased cardiac output, slows HR

● Absorption: 60–80% absorbed after PO, 70– 85% elixir, 80% IM sites.(IM route not recommended due to pain/irritation)

● Distribution: Widely distributed; crosses placenta, enters breast milk.

● Protein binding: 20–30%

● Metabolism&Excretion: Excreted almost entirely unchanged by the kidneys 

● Onset/Peak/Duration: PO: Onset 0.5 hr-2hrs, Peak 2–6 hr, Duration 2–4 days, IV: Onset 5–30 min, Peak 1–5 hr, Duration 2–4 days, MI : Onset 0.5hr, Peak 4-6 hr, Duration 2–4 days

● ADE: CV: ARRHYTHMIAS, bradycardia, ECG changes, AV block, SA block. EENT: blurred vision, yellow or green vision. GI: anorexia, nausea, vomiting, diarrhea. Hemat: thrombocytopenia. Metab: electrolyte imbalances with acute digoxin toxicity. Neuro: fatigue, headache, weakness..

● Dose: Adult: PO: Loading dose 0.75–1.25 mg given as 50% of the dose initially, then maintenance 0.125–0.5 mg/day  depending on patient’s lean body weight, renal function, and serum level, IV, IM: Digitalizing dose— 0.5– 1 mg given as 50% of the dose initially, one quarter of the initial dose in each of 2 subsequent doses at q6h as needed 

● considerations: Always check apical pulse for 1 full minute before administration; hold if HR < 60 bpm, Monitor ECG during IV q6h after each dose (bradycardia, new arrhythmias occur), Monitor serum digoxin level, Toxicity and Overdose: first symptoms, abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, other arrhythmias, Do not confuse Lanoxin (digoxin)