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What should be the dose of digitalis in heart failure?
DrAshokDeshmukh
The dose of digitalis or digoxin has been a problem for many years. So many patients do not tolerate the digoxin. There is toxicity of the drug. Patients feels nausea and gets vomiting. He may land up in cardiac arrhythmia, if you continue the drug. For years the patient was given a holiday on Sunday. So he was not supposed to take the drug on Sunday. Then Saturday off was also added to this. But the toxicity continued to occur. The half life of the drug is 36 to 48 hours. So when the drug is given on alternate day, it was found to work without the toxicity in almost all the patients. It may not be totally effective in this dose to control the heart failure. But that is what you get from digoxin. If you want the drug to work more, the toxicity is the result of such an attempt. If you get toxicity in alternate day dose, then your patient is in hypokalemia. You should give oral potassium supplement in such a case. Above dose is for the patients with normal kidney functions.
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What are the nursing responsibilities of digitalis?
Digitalis has a very narrow therapeutic index, therefore, the dose must be carefully be monitored for each patient.
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What is digitalis or a drug called digoxin?
Digitalis has got digoxin and digitoxin in the extract of the plant Digitalis lanata. Digitoxin has got very long half life and should not be used in therapeutics. Digoxin is drug of therapeutic value. It is very good drug for congestive heart failure. Digoxin has very unique mode of action. It takes less oxygen for heart to do the same amount of work. Alternately, your heart work more with the same amount of oxygen, when on digoxin. You may give the loading dose of two tablets of 0.25 mg. Fallowed by one after say twelve hours. Then 3/4 tablet daily after 24 hours. When there is no urgency, you should give 3/4 tablet daily, from the begining. You may need to give potassium supplement in some, specially when the patient is taking no food for a day or two. With signs of toxic effects, you should stop the drug. The rule of thumb is 'Nausea'. When the patient feels like vomiting, he may be getting overdose of digoxin. Otherwise, there may be hypokalemia or low level of potassium. Most common cause for the same is no food intake or loose motion. If you continue to give digoxin, patient will go for vomiting. Natures way to get rid of digoxin. if you continue to give digoxin, you have serious side effects, like digoxin induced cardiac arrhythmias.
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