From the Guidelines
The recommended dose of digoxin for a patient with tachycardia (fast ventricular response) is typically 0.125 to 0.25 mg daily, with no need for a loading dose. According to the 2009 ACCF/AHA Heart Failure Guidelines 1, therapy with digoxin is commonly initiated and maintained at this dose range.
Key Considerations
- Low doses (0.125 mg daily or every other day) should be used initially if the patient is more than 70 years old, has impaired renal function, or has a low lean body mass 1.
- Higher doses (e.g., digoxin 0.375 to 0.50 mg daily) are rarely used or needed in the management of patients with heart failure 1.
- Doses of digoxin that achieve a concentration of drug in plasma in the range of 0.5 to 1.0 ng per mL are suggested, given the limited evidence currently available 1.
Important Factors to Consider
- Serum digoxin levels should be monitored to avoid toxicity, which can occur with levels greater than 2 ng per mL 1.
- The concomitant use of certain drugs, such as clarithromycin, erythromycin, amiodarone, itraconazole, cyclosporine, verapamil, or quinidine, can increase serum digoxin concentrations and may increase the likelihood of digitalis toxicity 1.
- Baseline electrolytes, renal function, and an ECG should be obtained before initiating therapy to ensure safe use of digoxin.
Monitoring and Adjustments
- The dose of digoxin should be adjusted based on the patient's response, renal function, age, and body weight 1.
- Regular monitoring of serum digoxin levels and electrolytes is essential to prevent toxicity and ensure optimal therapy.
From the FDA Drug Label
The doses of digoxin used for the treatment of chronic atrial fibrillation should be titrated to the minimum dose that achieves the desired ventricular rate control without causing undesirable side effects. Peak digoxin body stores larger than the 8 to 12 mcg/kg required for most patients with heart failure and normal sinus rhythm have been used for control of ventricular rate in patients with atrial fibrillation
The dose of digoxin for a patient with tachycardia (fast ventricular response) should be titrated to the minimum dose that achieves the desired ventricular rate control.
- The usual amount of digoxin tablets that a 70 kg patient requires to achieve 8 to 12 mcg/kg peak body stores is 750 to 1250 mcg (0.75 to 1.25 mg).
- Doses may be increased every 2 weeks according to clinical response.
- In patients with chronic atrial fibrillation, digoxin slows rapid ventricular response rate in a linear dose-response fashion from 0.25 to 0.75 mg/day 2.
From the Research
Dose of Digoxin for Fast Ventricular Response
The dose of digoxin for a patient with tachycardia (fast ventricular response) is not explicitly stated in the provided studies. However, the following points can be considered:
- Digoxin is used to control ventricular response rate in patients with atrial fibrillation (AF) 3, 4, 5.
- The effectiveness of digoxin in controlling heart rate is compared to other medications such as beta-blockers and calcium channel blockers in patients with sepsis and AF with rapid ventricular response 6.
- Digoxin may be useful in combination with a beta-blocker to achieve satisfactory rate control in patients with heart failure (HF) and AF 5.
- There is no mention of a specific dose of digoxin for fast ventricular response in the provided studies.
Key Points to Consider
- The choice of medication for rate control in AF depends on various factors, including the presence of underlying heart disease and the patient's clinical condition 3, 4, 5.
- Beta-blockers and calcium channel blockers are commonly used to control ventricular response rate in AF 3, 6, 7.
- Digoxin may be considered as an adjunctive therapy in certain cases, such as in patients with HF and AF 5.
- The dose of digoxin would depend on various factors, including the patient's renal function, age, and clinical condition, but this information is not provided in the studies.