Pronunciation:

di-JOX-in

Brand Names:

• Lanoxin
• Lanoxin Pediatric

Dosage Forms:

• Solution
• Injectable

Classifications:

Therapeutic—

Cardiovascular Agent

Pharmacologic—

Cardiac Glycoside

Chemical—

Digitalis Glycoside

Uses of This Medicine:

Digoxin injection is used in combination with a diuretic ("water pill") and an angiotensin-converting enzyme (ACE) inhibitor to treat congestive heart failure and a heart rhythm problem called atrial fibrillation.

Digoxin injection belongs to the class of medicines called digitalis glycosides. It is used to improve the strength and efficiency of the heart, or to control the rate and rhythm of the heartbeat. This leads to better blood circulation and reduced swelling of the hands and ankles in patients with heart problems.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of digoxin injection in children. However, infants are more likely to be very sensitive to the effects of digoxin injection which may require an individual dose for infants receiving digoxin injection.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of digoxin injection in the elderly. However, elderly patients are more likely to have age-related kidney or heart problems which may require an adjustment in the dose for patients receiving digoxin injection.

Pregnancy—

Breast-feeding—

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Alprazolam
• Amiodarone
• Bemetizide
• Bendroflumethiazide
• Benzthiazide
• Buthiazide
• Calcium
• Chan Su
• Chlorothiazide
• Chlorthalidone
• Clopamide
• Conivaptan
• Cyclopenthiazide
• Cyclothiazide
• Demeclocycline
• Diphenoxylate
• Doxycycline
• Dronedarone
• Erythromycin
• Hydrochlorothiazide
• Hydroflumethiazide
• Indapamide
• Indomethacin
• Itraconazole
• Kyushin
• Lily of the Valley
• Methyclothiazide
• Metolazone
• Minocycline
• Oleander
• Oxytetracycline
• Pheasant's Eye
• Polythiazide
• Propafenone
• Propantheline
• Quercetin
• Quinethazone
• Quinidine
• Ritonavir
• Saquinavir
• Spironolactone
• Squill
• Succinylcholine
• Tetracycline
• Trichlormethiazide
• Verapamil
• Xipamide

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Acarbose
• Acebutolol
• Alprenolol
• Arbutamine
• Atenolol
• Atorvastatin
• Azithromycin
• Azosemide
• Bepridil
• Betaxolol
• Bevantolol
• Bisoprolol
• Bucindolol
• Canrenoate
• Carteolol
• Carvedilol
• Cascara Sagrada
• Celiprolol
• Colchicine
• Cyclosporine
• Darunavir
• Dilevalol
• Diltiazem
• Disopyramide
• Epoprostenol
• Esmolol
• Etravirine
• Flecainide
• Fluoxetine
• Furosemide
• Gatifloxacin
• Hydroxychloroquine
• Indecainide
• Labetalol
• Lenalidomide
• Lornoxicam
• Mepindolol
• Metipranolol
• Metoclopramide
• Metoprolol
• Mibefradil
• Nadolol
• Nebivolol
• Nefazodone
• Nilvadipine
• Nisoldipine
• Nitrendipine
• Omeprazole
• Oxprenolol
• Pancuronium
• Paromomycin
• Penbutolol
• Pindolol
• Piretanide
• Posaconazole
• Propranolol
• Quinine
• Rabeprazole
• Ranolazine
• Rifampin
• Rifapentine
• Roxithromycin
• Simvastatin
• Sotalol
• Sulfasalazine
• Talinolol
• Telithromycin
• Telmisartan
• Tertatolol
• Timolol
• Torsemide
• Tramadol
• Trazodone
• Trimethoprim

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Blood vessel disease (e.g., arteriovenous shunt) or
• Hypocalcemia (low calcium in the blood) or
• Hypoxia (low oxygen in the blood) or
• Thyroid disease—Use with caution. Patients with these conditions may be less sensitive or resistant to the effects of digoxin injection.

• Electrical cardioversion (a medical procedure)—Dose of digoxin injection may be reduced 1 to 2 days prior to electrical cardioversion of atrial fibrillation to avoid worsening of the condition.

• Heart disease (e.g., amyloid heart disease, AV block, constrictive pericarditis, cor pulmonale, heart attack, hypertrophic cardiomyopathy, restrictive cardiomyopathy, sick sinus syndrome, Wolff-parkinson-white syndrome) or
• Hypercalcemia (high calcium in the blood) or
• Hypokalemia (low potassium in the blood) or
• Hypomagnesemia (low magnesium in the blood)—Use with caution. May make these conditions worse.

• Kidney disease—Use with caution. The effects may be increased because of slower removal from the body.

• Ventricular fibrillation (heart rhythm problem)—Should not be used in patients with this condition.

Proper Use of This Medicine:

A nurse or other trained health professional will give you this medicine in a hospital. This medicine is given usually through a needle placed in one of your veins or sometimes as a shot deep into your muscles.

Your doctor may give you a few doses of this medicine until your condition improves, and then you may be switched to an oral medicine that works the same way. If you have any concerns about this, talk to your doctor.

Precautions While Using This Medicine:

It is very important that your doctor check your progress closely while you are using this medicine to see if it is working properly and to allow for a change in the dose. Blood tests may be needed to check for any unwanted effects.

Do not stop taking this medicine without first checking with your doctor. Stopping suddenly may cause a serious change in heart function.

Watch for signs and symptoms of overdose while you are taking this medicine. Follow your doctor's directions carefully. The amount of this medicine needed to help most people is very close to the amount that could cause serious problems from overdose. Some early warning signs of overdose are loss of appetite, nausea, vomiting, diarrhea, or problems in seeing. Other signs of overdose are changes in the rate or rhythm of the heartbeat (becoming irregular or slow), palpitations (feeling of pounding in the chest), or fainting. In infants and small children, the earliest signs of overdose are changes in the rate and rhythm of the heartbeat. Children may not show the other symptoms as soon as adults.

Your doctor may want you to carry a medical identification card or bracelet stating that you are receiving this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Before having any tests, tell your doctor that you are using this medicine. This medicine may affect the results of certain medical tests.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

Dizziness

fainting

fast, pounding, or irregular heartbeat or pulse

slow heartbeat

Rare

Black, tarry stools

bleeding gums

blood in the urine or stools

bloody vomit

pinpoint red spots on the skin

rash with flat lesions or small raised lesions on the skin

severe stomach pain

unusual bleeding or bruising

Incidence not known

Chest pain or discomfort

nausea

shortness of breath

sweating

swelling of the feet and lower legs

troubled breathing

unusual tiredness or weakness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

Agitation or combativeness

anxiety

confusion

depression

diarrhea

expressed fear of impending death

hallucinations

rash

vomiting

Rare

Abdominal or stomach pain

Incidence not known

Blurred or loss of vision

disturbed color perception

double vision

halos around lights

headache

lack of feeling or emotion

loss of appetite

night blindness

overbright appearance of lights

swelling of the breasts or breast soreness in both females and males

tunnel vision

uncaring

weakness

weight loss

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.