Digoxin is a complicated medicine with a variety of limit, but is often used

effectively and safely when given to patients under sufficient monitoring and at
acceptable doses. In patients suffering from heart failure, a concentration of 0.50.9 ng per mL is targeted which would inhibit the sodium potassium ATPase
pump optimally causing a positive inotropic response. The heart failure patients
do not require a loading dose and are typically started immediately on
maintenance treatment. In patients suffering from atrial fibrillation, digoxin
retards the AV node conductions causing the negative chronotropic response. In
this case, patients should be initiated on a load dose of 0.5-1.0 mg and following
this, a maintenance dose of less than 0.25 mg every day. This value should be
calculated according to the factor specific to the individual patient, for example,
renal insufficiency, low body weight, whether they are elderly and the other
medicines that the patient is taking. The maintenance dose can be titrated to
either a target concentration of 0.8-2 ng per mL or until the preferred clinical
response is achieved.
Digoxin has an alternating pharmacokinetic profile and the patient concentration
should be observed closely, especially in elderly patients, patients who have
renal insufficiency and patients with lean body weight that is low. The gathered
digoxin levels should be founded on the whole clinical profile of the patient and a
steady state should be achieved in between 5-20 days according to the renal
insufficiency of the patient. When digoxin enters the body, it is metabolised in
the liver, but unlike most drugs is metabolised outside of the cytochrome P450
system and is removed from the body in the urine. However, digoxin interactions
are commonplace, especially with the P glycoprotein ATP dependant drug efflux
pump and because of this changes to the digoxin dose might be required. The
primary inclinations of digoxin toxicity are an appetite loss and feelings of
sleepiness, although the toxicity signs can become vastly more severe. These
typically occur when the blood serum digoxin concentration levels become larger
than 2 ng per mL. In these cases and if it is a clinical requirement, digoxin
immune fab has great efficacy in the reversal of digoxin toxicity and its
subsequent effects.
Although, digoxin has a vast array of limits, primarily down to the alternating
pharmacokinetics and a thin therapeutic index, digoxin can be used safely and
with great efficacy when given at the correct dose alongside acceptable and
sufficient monitoring depending on the individual specific patient factors.