DIGITALIS PREPARATIONS (Digitalis Glycosides)

Brand & Generic Names

Cedilanid
Crystodigin
DIGITALIS
DIGITOXIN
DIGOXIN
Lanoxicaps
Lanoxin
Novodigoxin

Basic Information

• Habit forming? No
• Prescription needed? Yes
• Available as generic? Yes
• Drug class: Digitalis preparation

Uses

• Strengthens weak heart-muscle contractions to prevent congestive heart failure.
• Corrects irregular heartbeat.

Dosage & Usage Information

How to take:
Tablet or capsule--Swallow with liquid. If you can't swallow whole, crumble tablet or open capsule and take with liquid or food.
Liquid--Dilute dose in beverage before swallowing.

When to take:
At the same time each day.

If you forget a dose:
Take as soon as you remember up to 12 hours late. If more than 12 hours, wait for next scheduled dose (don't double this dose).

What drug does:
Strengthens heart-muscle contraction.
Delays nerve impulses to heart.

Time lapse before drug works:
May require regular use for a week or more.

Don't take with:
Non-prescription drugs without consulting doctor.
Any other medicine without consulting your doctor or pharmacist.

Overdose

SYMPTOMS:
Nausea, vomiting, diarrhea, vision disturbances, halos around lights, fatigue, irregular heartbeat, confusion, hallucinations, convulsions.

WHAT TO DO:

• Dial 911 (emergency) or O (operator) for an ambulance or medical help. Then give first aid immediately.
• See EMERGENCY Information.

Possible Adverse Reactions or Side Effects

Life-threatening:

In case of overdose, see Overdose section.

Common:

Appetite loss, diarrhea.

Infrequent:

Extreme drowsiness, lethargy, disorientation, headache, fainting.

Rare:

• Rash, hives, cardiac arrhythmias, hallucinations, psychosis.
• Double or yellow- green vision; enlarged, sensitive male breasts; tiredness; weakness; depression; decreased sex drive.

Warnings & Precautions

Don't take if:

• You are allergic to any digitalis preparation.
• Your heartbeat is slower than 50 beats per minute.

Before you start, consult your doctor:

• If you have taken another digitalis preparation in past 2 weeks.
• If you have taken a diuretic within 2 weeks.
• If you have liver or kidney disease.
• If you have a thyroid disorder.
• If you will have surgery within 2 months, including dental surgery, requiring general or spinal anesthesia.

Over age 60:
Adverse reactions and side effects may be more frequent and severe than in younger persons.

Pregnancy:
Studies inconclusive on harm to unborn child. Consult your doctor.

Breast-feeding:
Drug filters into milk. May harm child. Avoid.

Infants & children:
Use only under medical supervision.

Prolonged use:
Talk to your doctor about the need for follow-up medical examinations or laboratory studies to check ECG*, liver function, kidney function, serum electrolytes.

Skin & sunlight:
No problems expected.

Driving, piloting or hazardous work:
Possible vision disturbances. Otherwise, no problems expected.

Discontinuing:
Don't stop without doctor's advice.

Others:
Some digitalis products contain tartrazine dye. Avoid, especially if you are allergic to aspirin.

Possible Interaction with Other Drugs

GENERIC NAME	COMBINED EFFECT
------------------------	-----------------------
Amiodarone	Increased digitalis effect.
Amphotericin B	Decreased potassium. Increased
	toxicity of amphotericin B.
Antacids*	Decreased digitalis effect.
Anticonvulsants,	Increased digitalis
hydantoin*	effect at first, then decreased.
Anticholinergics*	Possible increased digitalis
	effect.
Attapulgite	May decrease effectiveness
	of digitalis.
Beta-adrenergic	Increased digitalis
blockers*	effect.
Beta-agonists*	Increased risk of heartbeat
	irregularity.
Calcium supplements*	Decreased digitalis effects.
Carteolol	Can either increase or decrease
	heart rate. Improves irregular
	heartbeat.
Cholestyramine	Decreased digitalis effect.
Colestipol	Decreased digitalis effect.
Cortisone drugs*	Digitalis toxicity.
Dextrothyroxine	Decreased digitalis effect.
Disopyramide	Possible decreased digitalis
	effect.
Diuretics*	Possible digitalis toxicity.
	Excessive potassium loss that may
	cause irregular heartbeat.
Ephedrine	Disturbed heart rhythm. Avoid.
Epinephrine	Disturbed heart rhythm. Avoid.
Erythromycins*	May increase digitalis absorption.
Flecainide	May increase digitalis blood level.
Fluoxetine	May cause confusion, agitation,
	convulsions and high blood
	pressure. Avoid combining.
Hydroxychloroquine	Possible increased digitalis
	toxicity.
Itraconazole	Possible toxic levels of digitalis.
Laxatives*	Decreased digitalis effect.
Metoclopramide	Decreased digitalis absorption.
Mineral oil	Decreased digitalis effect.
Nicardipine	Increased digitalis effect. May
	need to reduce dose.
Nizatidine	Increased digitalis effect.
Oxyphenbutazone	Decreased digitalis effect.
Paroxetine	Increased levels of paroxetine
	in blood.
Phenobarbital	Decreased digitalis effect.
Phenylbutazone	Decreased digitalis effect.
Potassium	Overdosage of either
supplements*	drug may cause severe heartbeat
	irregularity.
Propafenone	Increased effect of both drugs and
	increased risk of toxicity.
PTU/Metronidazole	Decreased digitalis effect.
Quinidine	Increased digitalis effect.
Rauwolfia	Increased digitalis
alkaloids*	effect.
Rifampin	Possible decreased digitalis
	effect.
Sotalol	Can either increase or decrease
	heart rate. Improves irregular
	heartbeat.
Spironolactone	Increased digitalis effect. May
	require digitalis dosage reduction.
Sulfasalazine	Decreased digitalis absorption.
Sympathomimetics*	Increased risk of heartbeat
	irregularities.
Tetracycline	May increase digitalis absorption.
Thyroid hormones*	Digitalis toxicity.
Ticlopidine	Slightly decreased digitalis
	effect (digoxin only).
Trazodone	Possible increased digitalis
	toxicity.
Triamterene	Possible decreased digitalis
	effect.
Verapamil	Increased digitalis effect.

Possible Interaction with Other Substances

INTERACTS WITH	COMBINED EFFECT
---------------	---------------
Alcohol:	None expected.
Caffeine drinks.	Irregular heartbeat. Avoid.
Cocaine:	Irregular heartbeat. Avoid.
Prune juice, bran	Decreased digitalis effect.
Marijuana:	Decreased digitalis effect.
Tobacco:	Irregular heartbeat. Avoid.