What is the frequency of digoxin (digitalis glycoside) administration?

From the Guidelines

Digoxin should be administered at a dose of 0.125 to 0.25 mg daily, with the frequency of administration being once daily, as this dosing regimen has been shown to be effective in managing heart failure while minimizing the risk of toxicity 1. The dosing frequency of digoxin is crucial in maintaining its therapeutic effects while preventing potential toxicity.

• The American College of Cardiology/American Heart Association joint committee on clinical practice guidelines recommends initiating and maintaining digoxin therapy at a dose of 0.125 to 0.25 mg daily 1.
• Low doses, such as 0.125 mg daily or every other day, should be used initially in patients over 70 years of age to minimize the risk of toxicity 1.
• The frequency of administration can be adjusted based on kidney function, as digoxin is primarily eliminated by the kidneys, and patients with renal impairment may require lower doses or less frequent administration 1.
• Regular monitoring of blood levels is essential to ensure that the therapeutic range of 0.8-2.0 ng/mL is maintained, and to minimize the risk of toxicity associated with higher serum concentrations 1.

From the FDA Drug Label

The doses of digoxin used in controlled trials in patients with heart failure have ranged from 125 to 500 mcg (0.125 to 0.5 mg) once daily. Therapy is generally initiated at a dose of 250 mcg (0. 25 mg) once daily in patients under age 70 with good renal function, at a dose of 125 mcg (0.125 mg) once daily in patients over age 70 or with impaired renal function, and at a dose of 62.5 mcg (0. 0625 mg) in patients with marked renal impairment. In general, divided daily dosing is recommended for infants and young children (under age 10)

The frequency of digoxin administration is once daily for adults, and divided daily dosing is recommended for infants and young children (under age 10) 2.

From the Research

Frequency of Digoxin Administration

The frequency of digoxin administration is not explicitly stated in the provided studies. However, the studies discuss the dosage and concentration of digoxin in patients with various conditions, such as atrial fibrillation and heart failure.

Dosage and Concentration

• The study 3 compares the serum digoxin levels in patients taking digoxin with a weekly interruption and those taking it continuously. The results show that the uninterrupted dosage is better at achieving serum digoxin levels within the therapeutic range.
• The study 4 assesses the correlation between predicted and measured serum digoxin concentrations in Chinese patients. The results indicate that the validity of the Konishi equation for individualizing digoxin dosage is limited.
• The study 5 evaluates the serum digoxin concentration in patients receiving digoxin therapy for heart failure. The results show that the mean serum digoxin concentration was 1.11±1.01 ng/mL, and 11.1% of patients had toxic levels.
• The study 6 evaluates the digoxin concentration after a loading dose in patients with renal dysfunction. The results show that patients with creatinine clearance below 60 mL/min were more likely to experience toxic serum digoxin concentrations.
• The study 7 determines the loading dose of digoxin in renal failure. The results show that an appropriate intravenous loading dose of digoxin in most patients with advanced renal failure is 10 microgram/kg.

Factors Affecting Digoxin Levels

• The study 5 finds that age, male gender, diabetes mellitus, and high HbA1c values are associated with greater serum digoxin concentrations.
• The study 6 finds that renal dysfunction, particularly creatinine clearance below 60 mL/min, predicts the likelihood of experiencing a toxic serum concentration of digoxin after a loading dose.