【藥品性質提示】 根據 2019 AGS Beers Criteria，本藥品為【潛在不適當用藥 (PIM)】，不建議用於老年人第一線治療。 #高警訊藥品

心律不整、心衰竭
Atrial fibrillation or atrial flutter: Control of ventricular response rate in adults with chronic atrial fibrillation
Heart failure with reduced ejection fraction (HFrEF): Mild to moderate (or stage C) heart failure in adults
#仿單變更2021#仿單變更2022

Antiarrhythmic Agent; Cardiac Glycoside:
1. Supraventricular arrhythmias: Direct suppression of the AV node conduction to increase effective refractory period and decrease conduction velocity.
2. Heart failure: Inhibition of the Na⁺-K⁺-ATPase pump in myocardial cells, which in turn promotes calcium influx leading to increased contractility.

Distribution
1. Vd: Extensive to peripheral tissues, heart/serum concentration is 70:1
2. Protein binding:~25%
Metabolism
only ~16% is metabolized to 3-beta-digoxigenin, 3-keto-digoxigenin, dihydrodigoxin<20220324>, and glucuronide and sulfate conjugates
Excretion
Mainly in urine, 50-70% as unchanged drug, by glomerular filtration and active tubular secretion
Pharmakodynamics
1. Therapeutic plasma concentrations: (adults) generally 0.5–2 ng/mL.
2. Onset of action: (Heart rate control)5 to 60 minutes
3. Duration: (Adult) 3-4 days

1. Ventricular fibrillation
2. Digitalis intoxication
3. Hypersensitivity to digoxin, other forms of digitalis

C; Although limited experience, the data is lacking association between the drug and congenital defects.

The amount of digoxin available to the infant via breast milk is not likely to be clinically significant. WHO considers digoxin to be compatible with breastfeeding

GI disturbance, anorexia (the earliest symptom of digoxin overdose), cardiac arrhythmia, conduction defect, blurred vision, halos around bright objects, disturbed color vision (yellow vision)

Administration:
IV preferred, inject slowly ≥5 minutes.
Atrial fibrillation/flutter: for rate control
Initial 0.25 to 0.5 mg over several minutes, with repeat doses of 0.25 mg Q6H to a maximum of 1.5 mg over 24 hours
Heart failure with reduced ejection fraction (HFrEF):
Loading dose not recommended

Loading dose:(IV)
1. Neonate(<1.5kg): 20 mcg/kg within 24 hours
2. Neonate(1.5-2.5kg): 30 mcg/kg within 24 hours
3. 1-24 months, 2-5 years of age: 35 mcg/kg within 24 hours
4. 5-10 years of age: 25 mcg/kg within 24 hours<2021/8/17>
Maintenance dose:
1. Neonate: 20% of loading dose within 24 hours
2. 1 month to 10 years of age: 25% of loading dose within 24 hours<2021/8/17>

Loading dose:
1. CrCl >15 mL/minute: No dosage adjustment necessary
2. CrCl ≤15 mL/minute: Administer 50% of usual dose
3. Hemodialysis, peritoneal dialysis: Use only when rapid ventricular rate control is necessary, reduce to 50% of usual dose
Maintenance dose:
1. CrCl ≥60 mL/minute: No dosage adjustment necessary
2. CrCl 45 to 60 mL/minute: 0.0625 to 0.125 mg once daily
3. CrCl 30 to 45 mL/minute: 0.0625 mg once daily
4. CrCl <30 mL/minute, hemodialysis, peritoneal dialysis: 0.0625 mg every 48 hours or consider alternative agent

No dosage adjustment necessary.