digoxin

Adult Dosing .

Dosage forms:  TAB: 62.5 mcg, 125 mcg, 250 mcg; SOL: 50 mcg per mL; INJ: various

Special Note

[formulation clarification]

Info: 100 mcg inj. = 125 mcg oral tab/solution

heart failure w/ reduced ejection fraction

[3.4-5.1 mcg/kg/dose PO qd]

Alt: 2.4-3.6 mcg/kg/dose IM/IV qd; Info: may load 10-15 mcg/kg PO or 8-12 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q6-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

atrial fibrillation

[immediate rate control]

Dose: 250 mcg IV q6h prn; Start: 250-500 mcg IV x1; Max: 1500 mcg/24h IV; Alt: 500 mcg PO x1, then 125-250 mcg PO q6-8h prn, max 8–12 mcg/kg/24h PO

[maintenance rate control]

Dose: 62.5-250 mcg PO qd; Max: 250 mcg/day

PSVT conversion (off-label)

[3.4-5.1 mcg/kg/dose PO qd]

Alt: 2.4-3.6 mcg/kg/dose IM/IV qd; Info: may load 10-15 mcg/kg PO or 8-12 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q6-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

renal dosing

[see below]

renal impairment: see pkg insert; Alt: give 25-75% usual dose q24-36h if eGFR 10-50; give 10-25% usual dose q48h if eGFR <10

HD: give 10-25% usual dose q48h; no supplement after dialysis; PD: give 10-25% usual dose q48h; no supplement

hepatic dosing

[no adjustment]

Peds Dosing .

Dosage forms:  TAB: 62.5 mcg, 125 mcg, 250 mcg; SOL: 50 mcg per mL; INJ: various

Special Note

[formulation clarification]

Info: 100 mcg inj. = 125 mcg oral tab/solution

heart failure w/ reduced ejection fraction

[premature neonates]

Dose: 4.7-7.8 mcg/kg/day (solution) PO divided q12h; Alt: 3.8-6.2 mcg/kg/day IM/IV divided q12h; Info: may load 20-30 mcg/kg (solution) PO or 15-25 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q4-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

[full-term neonates]

Dose: 7.5-11.3 mcg/kg/day (solution) PO divided q12h; Alt: 6-9 mcg/kg/day IM/IV divided q12h; Info: may load 25-35 mcg/kg (solution) PO or 20-30 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q4-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

[1 mo-2 yo]

Dose: 11.3-18.8 mcg/kg/day (solution) PO divided q12h; Alt: 9-13 mcg/kg/day IM/IV divided q12h; Info: may load 35-60 mcg/kg (solution) PO or 30-50 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q4-8; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

[2-5 yo]

Dose: 9.4-13.1 mcg/kg/day (solution) PO divided q12h; Alt: 7.6-10.6 mcg/kg/day IM/IV divided q12h; Info: may load 30-45 mcg/kg (solution) PO or 25-35 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q4-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

[5-10 yo]

Dose: 5.6-11.3 mcg/kg/day (solution) PO divided q12h or 6.4-12.8 mcg/kg/day (tab) PO divided q12h; Alt: 4.6-9 mcg/kg/day IM/IV divided q12h; Info: may load 20-35 mcg/kg (solution) PO, 20-45 mcg/kg (tab) PO, or 15-30 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q4-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

[>10 yo]

Dose: 3-4.5 mcg/kg/dose (solution) PO qd or 3.4-5.1 mcg/kg/dose (tab) PO qd; Alt: 2.4-3.6 mcg/kg/dose IM/IV qd; Info: may load 10-15 mcg/kg (solution or tab) PO or 8-12 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q6-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

atrial fibrillation (off-label)

[premature neonates]

Dose: 4.7-7.8 mcg/kg/day (solution) PO divided q12h; Alt: 3.8-6.2 mcg/kg/day IM/IV divided q12h; Info: for ventricular rate control; may load 20-30 mcg/kg (solution) PO or 15-25 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q4-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

[full-term neonates]

Dose: 7.5-11.3 mcg/kg/day (solution) PO divided q12h; Alt: 6-9 mcg/kg/day IM/IV divided q12h; Info: for ventricular rate control; may load 25-35 mcg/kg (solution) PO or 20-30 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q4-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

[1 mo-2 yo]

Dose: 11.3-18.8 mcg/kg/day (solution) PO divided q12h; Alt: 9-13 mcg/kg/day IM/IV divided q12h; Info: for ventricular rate control; may load 35-60 mcg/kg (solution) PO or 30-50 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q4-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

[2-5 yo]

Dose: 9.4-13.1 mcg/kg/day (solution) PO divided q12h; Alt: 7.6-10.6 mcg/kg/day IM/IV divided q12h; Info: for ventricular rate control; may load 30-45 mcg/kg (solution) PO or 25-35 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q4-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

[5-10 yo]

Dose: 5.6-11.3 mcg/kg/day (solution) PO divided q12h or 6.4-12.8 mcg/kg/day (tab) PO divided q12h; Alt: 4.6-9 mcg/kg/day IM/IV divided q12h; Info: for ventricular rate control; may load 20-35 mcg/kg (solution) PO, 20-45 mcg/kg (tab) PO, or 15-30 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q4-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

[>10 yo]

Dose: 3-4.5 mcg/kg/dose (solution) PO qd or 3.4-5.1 mcg/kg/dose (tab) PO qd; Alt: 2.4-3.6 mcg/kg/dose IM/IV qd; Info: for ventricular rate control; may load 10-15 mcg/kg (solution or tab) PO or 8-12 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q6-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

PSVT conversion (off-label)

[premature neonates]

Dose: 4.7-7.8 mcg/kg/day (solution) PO divided q12h; Alt: 3.8-6.2 mcg/kg/day IM/IV divided q12h; Info: may load 20-30 mcg/kg (solution) PO or 15-25 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q4-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

[full-term neonates]

Dose: 7.5-11.3 mcg/kg/day (solution) PO divided q12h; Alt: 6-9 mcg/kg/day IM/IV divided q12h; Info: may load 25-35 mcg/kg (solution) PO or 20-30 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q4-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

[1 mo-2 yo]

Dose: 11.3-18.8 mcg/kg/day (solution) PO divided q12h; Alt: 9-13 mcg/kg/day IM/IV divided q12h; Info: may load 35-60 mcg/kg (solution) PO or 30-50 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q4-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

[2-5 yo]

Dose: 9.4-13.1 mcg/kg/day (solution) PO divided q12h; Alt: 7.6-10.6 mcg/kg/day IM/IV divided q12h; Info: may load 30-45 mcg/kg (solution) PO or 25-35 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q4-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

[5-10 yo]

Dose: 5.6-11.3 mcg/kg/day (solution) PO divided q12h or 6.4-12.8 mcg/kg/day (tab) PO divided q12h; Alt: 4.6-9 mcg/kg/day IM/IV divided q12h; Info: may load 20-35 mcg/kg (solution) PO, 20-45 mcg/kg (tab) PO, or 15-30 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q4-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

[>10 yo]

Dose: 3-4.5 mcg/kg/dose (solution) PO qd or 3.4-5.1 mcg/kg/dose (tab) PO qd; Alt: 2.4-3.6 mcg/kg/dose IM/IV qd; Info: may load 10-15 mcg/kg (solution or tab) PO or 8-12 mcg/kg IM/IV, divided into 3 doses and given as 50% initially then 25% x2 q6-8h; use LBW for dose calculation; LBW = lean body wt in kg; refer to Lean Body Weight (Female) and Lean Body Weight (Male) calculators; adjust dose based on levels; IV preferred to IM

renal dosing

[see below]

renal impairment: see pkg insert; Alt: give 75% usual dose q12-24h if CrCl 30-50; give 50% usual dose q12-24h if CrCl 10-30; give 25% usual dose q12-24h if CrCl <10; Info: use modified Schwartz equation to estimate renal fxn

HD: give 25% usual dose q12-24h; no supplement after dialysis; PD: give 25% usual dose q12-24h; no supplement

hepatic dosing

[no adjustment]