Lanoxin (Digoxin)
Also sold as: Lanoxin, Digoxin, Cardioxin, Digitek
Pregnancy
Cat C
Lactation
Safe
Schedule
H
Forms
Tablet 0.0625mg, 0.125mg, 0.25mg +2
Indications
- Atrial fibrillation — ventricular rate control (especially HF + AF)
- Atrial flutter (rate control)
- Heart failure with reduced ejection fraction (adjunct, symptom relief)
Adult Dosing
AF rate control (non-urgent)
0.125-0.25 mg PO once daily
Use lower end in elderly, renal impairment, low body weight
AF loading (rapid oral)
0.5 mg PO then 0.25 mg every 6 hours × 2-3 doses
Followed by maintenance 0.125-0.25 mg daily
IV (urgent rate control)
0.25-0.5 mg IV over 20-30 min (infused slowly)
Repeat 0.25 mg every 4-6 hours if needed; total loading: 0.75-1.5 mg
Pediatric Dosing
Paediatric dosing is COMPLEX — consult paediatric cardiologist. Toxicity threshold is very narrow.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl > 50 mL/min | 0.125-0.25 mg daily |
| CrCl 10-50 mL/min | 0.0625-0.125 mg daily |
| CrCl < 10 mL/min / HD | 0.0625 mg daily or every other day — TDM essential |
Hepatic Adjustment
No dose adjustment required; digoxin not hepatically cleared
Pregnancy & Lactation
Pregnancy: Category C
Crosses placenta. Used for fetal supraventricular tachycardia. Monitor maternal digoxin levels closely.
Lactation: Safe
Small amounts in breast milk — considered compatible with breastfeeding.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Amiodarone | Doubles digoxin levels — reduce digoxin dose by 50% | Major |
| Verapamil / Diltiazem | Increases digoxin levels significantly — reduce dose, monitor | Major |
| Quinidine | Doubles digoxin levels | Major |
| Loop diuretics / thiazides | Hypokalaemia increases digoxin toxicity risk | Major |
| Spironolactone | Reduces digoxin renal clearance — increase levels ~25% | Moderate |
| Antacids / cholestyramine / kaolin | Reduce digoxin absorption — separate by 2 hours | Moderate |
| Azithromycin / clarithromycin / erythromycin | Increase digoxin levels via gut flora alteration | Major |
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Side Effects
Common
- Nausea
- Vomiting
- Anorexia
- Headache
- Visual disturbances (yellow-green vision)
Serious / Discontinue If
- Digoxin toxicity: bradycardia, AV block, ventricular arrhythmias (PVCs, VT, VF)
- Hypokalaemia-precipitated toxicity
- Gynaecomastia (long-term)
Contraindications
- Digoxin toxicity
- Ventricular fibrillation
- WPW syndrome with AF (risk of VF)
- Hypertrophic obstructive cardiomyopathy (HOCM)
- AV block (2nd/3rd degree, without pacemaker)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Lanoxin 0.25mg | GSK | 30 tab ₹38 |
| Cardioxin 0.25mg | Cipla | 30 tab ₹32 |
Monitoring Required
- Serum digoxin level: therapeutic 0.5-0.9 ng/mL (HF); 0.8-2 ng/mL (AF rate control) — draw trough at least 6-8 hours post-dose
- Serum potassium (hypoK = toxicity risk)
- Serum magnesium and calcium
- ECG (PR prolongation, ST sagging, T-wave inversion)
- Renal function every 3-6 months
Patient Counseling Points
- Take at the same time every day
- Do NOT double dose if missed
- Report: nausea, vomiting, seeing yellow-green halos around lights, irregular heartbeat, extreme fatigue
- Many drugs interact — check with doctor before adding any new medicine
- Regular blood tests and ECGs are essential
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Clinically reviewed by: Dr. Priya Sharma, DM (Cardiology), Senior Cardiologist
Last reviewed: 2026-04-01
References
- BNF — Digoxin
- ESC AF Guidelines 2023
- ACC/AHA HF Guidelines 2022
- DIG Trial