From the Guidelines
Digoxin dosing in acute atrial fibrillation is typically initiated at 0.5 mg intravenous bolus, with a total dose of 0.75-1.5 mg over 24 hours in divided doses.
Key Considerations
- The dosing of digoxin should be adjusted based on renal function, with lower doses used in patients with impaired renal function 1.
- The maintenance dose of digoxin is typically 0.0625-0.25 mg daily, with the goal of achieving a plasma concentration of 0.5-0.9 ng/mL 1.
- Higher doses of digoxin are rarely needed and may be associated with increased risk of adverse effects, including death 1.
Important Details
- In patients over 70 years of age, low doses (0.125 mg daily or every other day) should be used initially 1.
- Digoxin should be used with caution in patients with chronic kidney disease (CKD), and the dose should be adapted accordingly 1.
- The use of digoxin in acute atrial fibrillation is recommended in patients with heart failure (HF), particularly in those with reduced ejection fraction (EF) 1.
From the Research
Dosing for Digoxin in Acute Atrial Fibrillation
The dosing for digoxin in acute atrial fibrillation can be summarized as follows:
- A loading dose of digoxin is recommended to achieve a serum digoxin concentration (SDC) of 0.8-1.5 ng/mL 2
- The median total loading dose of digoxin for acute rate control in critically ill patients with atrial fibrillation/atrial flutter (AF/AFL) is 11mcg/kg (750 mcg) 2
- A more aggressive dosing regimen of digoxin may be more effective in terms of heart rate reduction 3
- The mean dose of digoxin used in a randomized, placebo-controlled multicentre trial was 0.88 +/- 0.35 mg 4
- A dose of 1.5 mg of digoxin intravenously over 12 hours has been used to treat acute atrial fibrillation 5
Key Considerations
- The dosing regimen for digoxin should take into account drug-drug interactions in the cardiac intensive care unit 2
- The effectiveness of digoxin in reducing heart rate is related to the initial heart rate, with patients having higher heart rates experiencing a more pronounced decrease 3
- Digoxin does not increase the rate of conversion to sinus rhythm, but has a fast-acting and clinically significant effect on heart rate 4
- The prognosis for quick reversion to sinus rhythm in patients with acute atrial fibrillation treated with rapid digitalization alone is excellent, but additional measures may be indicated if reversion does not occur by 16 to 24 hours 5
Comparison with Other Treatments
- Digoxin is superior to placebo in reducing heart rate, but inferior to beta blockers 6
- Digoxin is inferior to calcium antagonists and amiodarone in reducing heart rate, but the evidence is limited 6
- Digoxin reduces the probability of converting atrial fibrillation to sinus rhythm compared to amiodarone, but the evidence is limited 6