INTRODUCTION

DIXIN contains Digoxin which belongs to the group of medicine called cardiac glycosides. It is indicated for the treatment of arrhythmias and heart failure. An arrhythmia is a heart rhythm disorder characterized by abnormal generation and conduction of cardiac impulses leading to an irregular heartbeat. As a result, the heart beats at a wrong speed which causes chest pain, fluttering in the heart, fainting or dizziness. Heart failure is a chronic condition in which the heart does not pump adequate amount of blood required for the circulation. Symptoms includes fatigue, difficulty in breathing, shortness of breath, swollen legs and fast heartbeat.

Digoxin works by correcting the abnormal heart rhythm into a normal rhythm. It also improves cardiac contractility and ejection fraction which makes the heart pump more efficiently and increases blood circulation throughout the body. While taking this medicine, your doctor would periodically monitor your kidneys and concentration of digoxin in blood to avoid unwanted side effects. The most common side effects of taking this medicine are nausea, vomiting, palpitation, dizziness or blurred vision. Contact your doctor if any of the symptoms bothers you.

Before taking this medicine, inform your doctor if you have any heart disease apart from arrhythmia and heart failure. This medicine should be used with caution in patients having lung or kidney disease. If you are pregnant, or think you may be pregnant or breastfeeding, consult your doctor before taking this medicine. Your doctor would select an appropriate dose for you depending upon your condition.

USES OF DIXIN

• Arrhythmia
• Heart failure

HOW DIXIN WORKS

Digoxin directly stimulates the parasympathetic nervous system through vagus nerve and slows the electrical conduction in the AV (atrioventricular) node, thus decreasing the heart rate. It also increases cardiac contractility by reversibly inhibiting the activity of an enzyme called Na-K ATPase pump (sodium-pump) which is responsible for controlling the movement of ions into the heart. This increases the influx of sodium and calcium in the myocardial cells, leading to an increase in the force of contraction, thus making the heart pump more efficiently.

DIRECTIONS FOR USE

This medicine will be given to you only by a doctor or a nurse into the vein as an intravenous infusion over a period of 10-20 minutes. Your doctor will decide the correct dose and duration for you depending upon your age, body weight and health condition. Continue to take this medicine, as long as your doctor tells you to do so, to obtain better results.

SIDE EFFECTS OF DIXIN

HOW TO MANAGE SIDE EFFECTS

Nausea or vomiting:

Stick to simple meals. Do not eat rich or spicy food.

Diarrhea:

Drink lots of fluids, such as water or juice, to avoid dehydration. Do not take any medicines without speaking to a doctor.

Skin rash:

Avoid hot showers because hot water can irritate the skin. Do not rub or scratch the affected area. Use sunscreen and protective clothing when outdoors. Regularly use moisturizers to soothe and hydrate the affected area. If the symptom persists, contact your doctor.

Dizziness:

Try to rest and relax. Get enough sleep. Avoid traveling, driving or operating any tools or machines while you are feeling dizzy. If the symptom persists, contact your doctor for advice.

WARNING & PRECAUTIONS

INTERACTIONS

Talk to your doctor, if you are taking,

• diuretics (used to increase urine output) e.g. furosemide, hydrochlorothiazide, spironolactone
• medicine used to treat depression and other mental illness (e.g. nefazodone, lithium salts, bupropion, St. John’s wort)
• corticosteroids (used to treat allergy and inflammation) e.g. prednisolone, dexamethasone
• carbenoxolone (medicine used to strengthen the gastric mucosa)
• medicines used to treat heart problems such as high blood pressure, heart failure and chest pain (e.g. flecainide, nifedipine, diltiazem, losartan, valsartan, captopril, enalapril, atenolol, propranolol, carvedilol, dronedarone, telmisartan, felodipine, verapamil, amiodarone, ranolazine, tiapamil, quinidine, prazosin and propafenone)
• acarbose and canagliflozin (used to treat diabetes)
• medicines used to treat bacterial infection (e.g. erythromycin, tetracycline, clarithromycin, trimethoprim, neomycin, penicillamine, rifampicin or gentamicin)
• flibanserin (used to treat low sexual desire in women)
• itraconazole or isavuconazole (used to treat fungal infections)
• ivacaftor (a medicine used to treat cystic fibrosis)
• alprazolam (a medicine used to treat anxiety)
• non-steroidal anti-inflammatory drugs (e.g. indomethacin)
• quinine (a medicine used to prevent malaria)
• propantheline (a medicine used to prevent muscle spasms)
• mirabegron (a medicine used to treat overactive bladder and urinary incontinence)
• cholestyramine and atorvastatin (used to reduce high blood cholesterol levels)
• cyclosporine (a medicine used to prevent graft rejection)
• epoprostenol (used to treat pulmonary arterial hypertension)
• medicines used to treat low sodium levels in the blood (e.g. tolvaptan or conivaptan)
• ritonavir (used to treat HIV infection)

SYNOPSIS

MORE INFORMATION

Store below 20-25°C and keep out of reach of children.

FAQs ABOUT DIXIN

Can DIXIN and metoprolol be taken together?

No. Avoid concomitant use of this medicine with beta-blocker (e.g. atenolol, metoprolol) because it may increase the risk of irregular heartbeat.

Can you stop taking DIXIN abruptly?

No. Do not stop taking this medicine abruptly without consulting your doctor, because it may worsen your existing condition.

Can I drink alcohol while taking DIXIN?

No. Avoid consumption of alcohol while taking this medicine.

Is DIXIN a steroid?

No. This medicine is not a steroid. It is a cardiac glycoside used to treat arrhythmia (abnormal heartbeat) and heart failure.

REFERENCES

1. KD. Tripathi. Cardiac Glycosides and Drugs for Heart Failure. Essentials of medical pharmacology. Seventh edition. 2013. Page – 512-519.

2. Kevin J. Sampson and Robert S. Kass. Anti-Arrhythmic Drugs. Goodman & Gilman’s: The Pharmacological basics of Therapeutics. 12th Edition. New York McGraw Hill Medical 2011. Page – 837-839.

3. Gerald G. Briggs and Roger K. Freeman. D. A reference guide to fetal and neonatal risk: Drugs in Pregnancy and Lactation. Tenth Edition. 2015. Page – 1172-1174.

4. National Heart, Lung, and Blood Institute (NHLBI). Digitalis Investigation Group (DIG).  NIH U.S. National Library of Medicine ClinicalTrials.gov. [Revised on July 2016] [Accessed 30th January 2021] https://clinicaltrials.gov/ct2/show/NCT00000476

5. R A Kelly and T W Smith. Digoxin in heart failure: implications of recent trials. NIH National Library of Medicine, National center for biotechnology information. Pubmed.gov. October 1993. [Accessed 30th January 2021] https://pubmed.ncbi.nlm.nih.gov/8376681/

6. Sebastiano Virgadamo, Richard Charnigo, Yousef Darrat, Gustavo Morales and Claude S Elayi. Digoxin: A systematic review in atrial fibrillation, congestive heart failure and post myocardial infarction. NCBI; PMC US National Library of Medicine, National Institute of Health. November 2015. [Accessed 30th January 2021] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4660476/

7. GlaxoSmithKline Manufacturing S.p.A. Electronic Medicines Compendium (EMC); [Revised on December 2019] [Accessed 30th January 2021] https://www.medicines.org.uk/emc/files/pil.5462.pdf

8. DSM Pharmaceuticals, Inc. U.S. Food & Drug Administration. November 2019. [Accessed 30th January 2021] https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/009330s026lbl.pdf

USEFUL DIAGNOSTIC TESTS

• Kidney function test
• Electrocardiogram