**6.4.16 Digoxin**

Digoxin is an antiarrhythmic and cardiac glycoside drug (Kavakl et al, 1998). It is a highly active cardiac glycoside with a half-life of 48 hours (Dökmeci, 2000; Küçüködük, 1994).

*Uses:* Treatment of heart failure caused by diminished myocardial contractility. Treatment of SVT, atrial flutter, and atrial fibrillation (Young & Mangum, 2010).


Total digoxin dose; premature baby: 0.02 mg/kg PO, after birth of newborn; 0.01-0.03 mg/kg IM, IV / 0.04 mg/kg PO, infant; 0.03-0.04 mg/kg IM, IV / 0.05 mg/kg PO, children; 0.010-0.015 mg/kg IM, IV, PO. Higher doses result in fatal arrhythmias (Dökmeci, 2000; Küçüködük, 1994).

*Adverse Effects:* Toxic Cardiac Effects: PR interval prolongation, sinus bradycardia or SA block, trail or nodal ectopic beats, ventricular arrhythmias. Nontoxic Cardiac Effects: QTc interval shortening, ST segment sagging, T-wave amplitude dampening, heart rate slowing (Young & Mangum, 2010).

*The things to be considered by nurse applying the drug:* Before nurse administers Digoxin to a child he or she should very carefully obtain prior Digoxin use history. Serum digoxin, potassium, magnesium and calcium levels should be determined by laboratory investigations before digoxin administration. Nurse should measure radial heart rate for a minute before administrating the drug to child and if any abnormality presents he or she should check apical pulse and its rate, rhythm and properties and notify doctor. The drug can be administered by IV route either directly or via a solution including 5% dextrose or 9% sodium chloride. Absorption may delay if the drug is administered by oral route after meals. And absorption may also delay when administered with antacids. IM administration of drug is not advised especially for children with diabetics or mild tissue perfusion as it causes pain. When IM route is used the drug should be administered deep into a large muscle mass and then the area should be massaged after injection. No more than 5 mL should be administered in one area. In case that digoxin is administered with such drugs as diuretics which decrease potassium level and some antibiotics toxicity may develop. Besides, calcium should not be administered to digitalized children. It may have fatal consequences. If the drug is used for atrial fibrillation treatment purposes nurse should check heart rate and if it is below 60 or above 100 beats per minute then he or she should notify doctor. The drug should be administered with precaution and at fewer doses in children with hyperkalemia having kidney and hepatic impairment. The inputs/outputs of child should be followed, edema should be monitored and daily weight check should be ensured. Cardiac arrhythmia and anorexia in children are early symptoms of toxicity. Nurse should pay attention to those symptoms. If it is suspected of toxicity blood digoxin level should be measured and EGK should be performed. Nurse should store the drug in tightclosed and light-proof bottles. If any color change is observed the drug should not be used (Kavakl et al, 1998).
