From the Guidelines
Digoxin 0.125 mg IV should be administered slowly over at least 5 minutes to minimize the risk of cardiac complications. When giving digoxin intravenously, it's crucial to push it slowly to avoid potential cardiac complications such as arrhythmias, as noted in the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1. The medication should be diluted according to institutional protocols (typically in 4 mL of sterile water or normal saline) and administered through a functioning IV line. During administration, monitor the patient's heart rate and rhythm, as digoxin has a narrow therapeutic window, with potential adverse effects including bradycardia, heart block, anorexia, nausea, vomiting, visual changes, and cardiac arrhythmias in cases of digoxin toxicity, as outlined in the guideline 1. The slow administration allows time to assess for adverse effects and helps prevent digoxin toxicity, which is particularly important because digoxin affects cardiac conduction and contractility by inhibiting the sodium-potassium ATPase pump, increasing intracellular calcium and strengthening heart contractions. Some key points to consider when administering digoxin include:
- Monitoring the patient's serum potassium levels before administration, as hypokalemia increases the risk of digoxin toxicity
- Being cautious in patients with renal dysfunction, as this can affect digoxin clearance and increase the risk of toxicity
- Avoiding the use of digoxin in patients with certain conditions, such as Wolff-Parkinson-White syndrome with atrial fibrillation or atrial flutter, or in patients with AV block greater than first degree or SA node dysfunction in the absence of a pacemaker, as outlined in the guideline 1.
From the FDA Drug Label
Administer the dose over a period of 5 minutes or longer and avoid bolus administration to prevent systemic and coronary vasoconstriction The dose of 0.125 mg of digoxin IV should be administered over a period of 5 minutes or longer to prevent systemic and coronary vasoconstriction 2.
- Key points:
- Administer dose over 5 minutes or longer
- Avoid bolus administration
- Prevent systemic and coronary vasoconstriction
From the Research
Administration of Digoxin
- The provided studies do not directly address the rate at which to push digoxin 0.125 mg IV.
- However, study 3 mentions that digoxin IV at 0.25 mg/kg was administered to induce hyperkalemia, arrhythmias, and death in a porcine model, but it does not provide information on the administration rate.
- Study 4 discusses the pharmacokinetics of digoxin when ingested orally, and study 5 focuses on the pharmacokinetics of digoxin-specific Fab therapy in the management of digitalis toxicity, neither of which provides information on IV administration rates.
- Study 6 analyzes the effects of intravenous calcium in patients with digoxin toxicity, but it does not address the administration rate of digoxin itself.
- Study 7 provides an overview of digoxin's current use and approach to toxicity, but it does not specify the administration rate for IV digoxin.
Relevant Considerations
- The studies provided do not offer direct guidance on the administration rate for IV digoxin.
- It is essential to consult relevant clinical guidelines or medical resources for specific information on administering digoxin IV, including the recommended rate.
- The administration of digoxin, especially in critical care settings, should be guided by evidence-based practices and clinical expertise to ensure patient safety.