DIGOXIN (Digoxinum; synonym: Cedoxin, Cordioxyl, Digolan, Lanacordin, Oxydigitoxin etc.; joint venture. A) — cardiotonic means. The glycoside allocated from leaves of a woolly foxglove (Digitalis lanata Ehrh.). Three digitoxoses, a total formula C contain aglikon digitoxigenin and as a sugar component 41 H 64 O 14
Represents white crystal powder, inodorous, almost water-insoluble, soluble in 70% ethanol.
, as well as other glycosides foxgloves (see), strengthens reductions of a myocardium, slows down heart rate, at heart failure increases minute volume, reduces the mass of the circulating blood and causes some other positive shifts in a hemodynamics, raises a diuresis. The cardiotonic effect at intravenous administration of D. develops in 15 — 25 min., at intake — in 2,5 hours. The maximum effect is noted respectively in 2 — 3 and 5 — 7 hours. At the same time D.'s maintenance in blood serum makes 1 — 2 ng/ml. At D.'s concentration more than 3 ng/ml can appear symptoms of intoxication.
For children toxic concentration of D. in blood, apparently, much higher. Unlike digitoxin (see) causes effect quicker, contacts serum proteins more weakly, it is quicker brought out of an organism and kumulirut less. In this regard after D.'s cancellation in 1 — 2 day in the presence of indications the patient can enter strophanthin.
At intake of D. it is well soaked up in went. - kish. a path (coefficient of a resorption of 60 — 70%) it is also rather long circulates in an organism: the most part of a dose is removed with bile in a gleam of intestines where again it is soaked up, and thus enterogepatichesky circulation is provided; an insignificant part of a dose collapses in a liver. Transmutation products (15 — 20% of the accepted dose), as well as not changed D., are allocated preferential with kidneys. The elimination half-life averages apprx. 1,5 days.
Apply D. at acute and chronic heart failure, a Bouveret's disease and tachyarrhythmias, in case of bad portability of other glycosides of a foxglove, and also to prevention of heart failure. Appoint inside and intravenously. Dose individually. In the 1st day appoint on 1 tablet 4 — 5 times a day (0,001 — 0,00125 g), for the 2nd day repeat a dose or reduce to 3 tablets a day (0,00075 g), on 3 — the 5th day maintenance doses — from 2 about one / 2 appoint tablets. According to the sparing scheme D. appoint within a week 2 — 3 tablets a day. In case of need for acceleration of approach to lay down. effect (at a myocardial infarction, etc.) D. enter intravenously, better kapelno.
At heavy disturbances of blood circulation of D. slowly enter into a vein 1 — 4 ml of 0,025% of solution (usually in 10 — 20 ml of 20 — 40% of solution of glucose) or kapelno (in 100 — 200 ml of 5% of solution of glucose or isotonic solution of sodium chloride). The maximum daily dose at intravenous administration of 1,5 mg (6 ml of 0,025% of solution).
In all cases of D.'s application by the patient it has to be found under careful medical control. It is necessary to consider that sensitivity of an organism to D. increases at a hypopotassemia (as a result of use of diuretics, laxatives etc.), a hypercalcemia, acidosis, a hypoxia, a hyperthyroidism, etc. It is necessary to be careful at D.'s appointment sick with coronary insufficiency, delay of conductivity, ventricular premature ventricular contraction, at an active endocarditis.
At D.'s overdose can make sick, vomiting, sharp bradycardia, ekstr an asystolia. At emergence of arrhythmia it is necessary to stop D.'s reception and if necessary to enter Pananginum, Unithiolum, antiarrhytmic means (e.g., Ajmalinum), etc.
D. is contraindicated at sharp bradycardia with the phenomena of an atrioventricular block, increase of attacks of stenocardia.
Forms of release: tablets on 0,00025 g and 0,025% solution in ampoules on 2 ml. Keep in the place protected from light.
See also Cardiac glycosides .
Bibliography: Votchal B. E. and Slutsk M. E. Cardiac glycosides, page 172, M., 1973, bibliogr.; Dmitriyev H. M and Gorchakova of N. A. Pharmakologiya of cardiac glycosides, in book: Pharm., Himioter. means, Toksikol., Probl, pharm., under the editorship of G. A. Stepansky, t. 3, page 52, M., 1972, bibliogr.; With and in-to about in I. I. and Kukes B. G. Chronic circulatory unefficiency, page 95, M., 1973, bibliogr.
Ya. I. Hadzhay.