From the FDA Drug Label
Digoxin is primarily excreted by the kidneys; therefore, patients with impaired renal function require smaller than usual maintenance doses of digoxin Use in Patients with Impaired Renal Function: Deficiencies of these electrolytes may result from malnutrition, diarrhea, or prolonged vomiting, as well as the use of the following drugs or procedures: diuretics,amphotericin B, corticosteroids, antacids, dialysis, and mechanical suction of gastrointestinal secretions. Severe digitalis intoxication can cause a massive shift of potassium from inside to outside the cell, leading to life-threatening hyperkalemia.
The role of Digoxin in patients with impaired renal function and those undergoing dialysis who have hyperkalemia is not directly related to treating hyperkalemia. Digoxin is primarily used to treat conditions like atrial fibrillation and heart failure. In patients with impaired renal function, the dose of digoxin should be reduced to avoid toxicity. Hyperkalemia caused by massive digitalis toxicity is best treated with DIGIBIND, and initial treatment with glucose and insulin may also be required if hyperkalemia itself is acutely life-threatening 1 1.
From the Research
Role of Digoxin in Patients with Impaired Renal Function
- Digoxin is a cardiac glycoside that can be used in patients with impaired renal function, but its use requires careful consideration of the patient's renal function and the potential for toxicity 2.
- The clearance of digoxin is directly related to the normal renal clearance of the drug, and patients with impaired renal function may experience a prolongation of the pharmacological action of digoxin 2.
- The efficiency of hemodialysis in eliminating digoxin is low, but the plasma concentration of digoxin can decrease rapidly during hemodialysis due to a decrease in the apparent volume of distribution of the drug 2.
Hyperkalemia in Patients with Impaired Renal Function
- Hyperkalemia can occur in patients with impaired renal function who are taking digoxin, and this can be a potentially life-threatening complication 3.
- Digoxin toxicity can cause hyperkalemia, and this can occur even in patients who are taking therapeutic doses of the drug 3.
- The combination of hyperkalemia, hypermagnesemia, hypocalcemia, and acidosis can reduce the myocardial sensitivity to digoxin and increase the risk of toxicity 2.
Management of Digoxin Toxicity in Patients with Impaired Renal Function
- Digoxin-specific Fab antibody fragments can be used to treat digoxin toxicity in patients with impaired renal function, and this can be an effective treatment option 4.
- Peritoneal dialysis can be used in patients with end-stage renal disease who have digoxin toxicity, but it is not associated with an enhanced clearance of digoxin 4.
- The use of digoxin in patients with impaired renal function requires careful monitoring of the patient's renal function and the potential for toxicity, and the dose of the drug may need to be adjusted accordingly 2, 5.
Clinical Outcomes in Patients with Impaired Renal Function
- Digoxin can improve renal function in some patients with chronic heart failure, and this can be associated with improved clinical outcomes 6.
- However, the use of digoxin in patients with impaired renal function can also be associated with an increased risk of primary cardiac arrest, particularly in patients with moderate renal impairment 5.