Digoxin, Oral/Injection dih-JOKS-in

What are other names for this medicine?

Type of medicine: antiarrhythmic (treats irregular heartbeat); cardiac glycoside

Generic and brand names: digoxin, oral; Lanoxin; digoxin, injection

What is this medicine used for?

This medicine is taken by mouth or given by IV infusion (slow drip through a needle into a large vein) to treat heart failure or atrial fibrillation.

It may be used for other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine
• problems with calcium, potassium, or magnesium levels in your blood
• kidney disease
• other heart problems or recent heart attack
• thyroid problems

Talk with your healthcare provider about the signs of overdose. The dosage you need to take may be very close to the amount that can cause dangerous side effects. Follow directions carefully, and report any side effects to your healthcare provider right away.

Tell your healthcare provider about any other medicines you are taking, including nonprescription products. Do not take any other medicines unless your healthcare provider approves.

Females of childbearing age: Talk with your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I take it?

The injection form of this medicine is given while you are in the hospital. You will be monitored closely while receiving this medicine.

If you have the oral form of this medicine, check the label on the medicine for directions about your specific dose. Take this medicine regularly and exactly as your healthcare provider prescribes, even if you feel better. Do not take more or less than prescribed. Do not stop taking this medicine without your healthcare provider's approval. Do not change the brand you are taking. Other brands may affect you differently.

You may take this medicine with or without food. Taking it with meals may lessen the chance the drug will upset your stomach.

If you have the liquid form of this medicine, use the measuring device (specially marked dropper) given to you by the pharmacist (not a common kitchen spoon) to make sure you get the right dose.

Discuss the use of fiber and your medicines with your healthcare provider or pharmacist. Your body may absorb less of this medicine if you eat a diet high in bran fiber. Also, do not change the amount of potassium in your diet without talking with your provider.

What if I miss a dose?

If you miss a dose, take it as soon as you remember if you remember within 12 hours. If you remember after 12 hours have passed, skip the missed dose and take the next one as directed. Do not take double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: nausea; vomiting; diarrhea; dizziness; blurred vision; confusion; seizures; hallucinations; tiredness; fast, slow or irregular heartbeat.

What should I watch out for?

Check your pulse regularly, and contact your healthcare provider right away if it gets too slow or too fast. Your healthcare provider will tell you how fast your pulse should be. You may also need to check your blood pressure and weight regularly.

You will need to have blood tests regularly to see how this medicine affects you. Keep all appointments for these tests.

Talk with your healthcare provider about whether you should take potassium or magnesium supplements.

Adults over the age of 65 may be at greater risk for side effects. Talk with your healthcare provider about this.

If you need emergency care, surgery, or dental work, tell the healthcare provider or dentist you are taking this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (report these to your healthcare provider right away): Nausea; severe vomiting or diarrhea; hallucinations (seeing things that are not there); severe stomach pain; yellowish vision, blurred vision, or seeing halos around objects; fast, slow, irregular, or pounding heartbeat; loss of appetite; unexplained swelling or weight gain; confusion; dizziness; fainting; depression; unexplained weakness or drowsiness; headache.

Other: enlarged breasts (in men).

Note: Because of the nature of this medicine and the medical conditions it is used for, contact your healthcare provider if you notice any ill effects or changes in your condition.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• acetazolamide (Diamox)
• antacids containing calcium or magnesium such as Maalox, Mylanta, and Tums (take them at least 2 hours before or after this medicine)
• antiarrhythmics (medicines to treat irregular heartbeat) such as amiodarone (Cordarone, Pacerone), dronedarone (Multaq), propafenone (Rythmol), and quinidine
• antibiotics such as azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin (Ery-Tabs, E.E.S.), neomycin (Neo-Fradin), rifampin (Rifadin, Rimactane), telithromycin (Ketek), and tetracycline
• antidepressants such as fluoxetine (Prozac, Sarafem), nefazodone, and trazodone
• antifungal medicines such as amphotericin B, itraconazole (Sporanox), ketoconazole (Nizoral), and posaconazole (Noxafil)
• anti-HIV medicines such as atazanavir (Reyataz), etravirine (Intelence), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase), and tipranavir (Aptivus)
• antiviral medicines such as boceprevir (Victrelis) and telaprevir (Incitek)
• atorvastatin (Lipitor)
• benzodiazepines such as alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), clorazepate (Tranxene, Gen-XENE), diazepam (Valium), lorazepam (Ativan), oxazepam, temazepam (Restoril), and triazolam (Halcion)
• beta blockers such as acebutolol (Sectral), atenolol (Tenormin), betaxolol (Kerlone), bisoprolol (Zebeta), carteolol, carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), pindolol, propranolol (Inderal), sotalol (Betapace), and timolol
• bronchodilators such as albuterol (Proventil), ephedrine, and terbutaline (Brethine)
• calcium channel blockers such as amlodipine (Norvasc), diltiazem (Cardizem, Dilacor, Tiazac), felodipine, isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Adalat, Procardia), and verapamil (Calan, Covera-HS, Isoptin SR, Verelan)
• carbamazepine (Tegretol)
• cholesterol-lowering medicines such as cholestyramine (Questran), and colestipol (Colestid) (take these 2 hours before or 4 hours after you take this medicine)
• corticosteroids such as betamethasone (Celestone), cortisone, dexamethasone, fludrocortisone (Florinef), hydrocortisone (Cortef), methylprednisolone (Medrol), prednisolone (Orapred), prednisone, and triamcinolone (Aristospan, Kenalog)
• cyclosporine (Gengraf, Neoral, Sandimmune)
• diabetes medicines such as acarbose (Precose), glipizide/metformin (Metaglip), metformin (Glucophage), rosiglitazone/metformin (Avandamet), sitagliptin (Januvia), and sitagliptin/metformin (Janumet)
• diphenoxylate (Lomotil)
• diuretics such as bumetanide, chlorthalidone (Thalitone), furosemide (Lasix), chlorothiazide (Diuril), hydrochlorothiazide (Microzide), indapamide (Lozol), methyclothiazide (Enduron), metolazone (Zaroxolyn), polythiazide (Renese), spironolactone (Aldactone), and torsemide (Demadex)
• epinephrine (EpiPen, Primatene Mist)
• heartburn or ulcer medicines such as cimetidine (Tagamet), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), ranitidine (Zantac), rabeprazole (AcipHex), and sucralfate (Carafate)
• hydroxychloroquine (Plaquenil)
• laxatives
• medicines to treat ulcerative colitis such as balsalazide (Colazal), mesalamine (Asacol), olsalazine (Dipentum), and sulfasalazine (Azulfidine)
• medicines used to treat cancer such as bleomycin, carmustine (BiCNU), cytarabine, cyclophosphamide, doxorubicin (Adriamycin), procarbazine (Matulane), vinblastine, and vincristine (Vincasar)
• medicines used to treat low sodium levels such as conivaptan (Vaprisol) and tolvaptan (Samsca)
• metoclopramide (Reglan)
• midodrine
• milnacipran (Savella)
• natural remedies such as adonis, aloe, cascara sagrada, chan su, chicory, devil's claw, dogbane root, ephedra, foxglove, ginger, ginseng, goldenseal, hawthorn, kelp, licorice, Lily of the Valley, milk thistle, senna, and St. John's wort
• nonsteroidal anti-inflammatory medicines (NSAIDs) such as diclofenac (Voltaren, Cataflam), ibuprofen (Motrin, Motrin IB, Advil), indomethacin (Indocin), ketoprofen, ketorolac (Toradol), nabumetone (Relafen), naproxen (Naprosyn, Anaprox, Aleve, Naprelan), oxaprozin (Daypro), piroxicam (Feldene), and sulindac (Clinoril)
• penicillamine (Cuprimine, Depen)
• propantheline
• quinine
• ranolazine (Ranexa)
• telmisartan (Micardis)
• teriparatide (Forteo)
• thyroid medicines such as levothyroxine (Levoxyl, Synthroid), liothyronine (Cytomel), liotrix (Thyrolar), propylthiouracil (PTU), and methimazole (Tapazole)
• tramadol (Ultram)

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.