Description

• The IV preparation is available in two concentrations:
  • The preparation in use will depend on availability and may change without notice.  Check all calculations carefully to ensure that the correct dose is given.
  • Lanoxin paediatric injection: clear, colourless solution 25 micrograms/ml in 2ml ampoules.
  • Lanoxin paediatric injection: 100micrograms/ml in 1ml ampoules.
    Note:  the 100 microgram/ml preparation is a Section 29 medication and the names of the infants receiving this preparation and the names of the specialist responsible for prescribing it must be recorded.
• Paediatric elixir for oral use: clear yellow solution 50 micrograms/ml in 50ml bottles.

Prescription

• Loading (digitalising) doses are charted on the stat page of the prescription chart in micrograms/dose.
• Maintenance doses are charted on the prescription chart in micrograms/dose.

Administration

Slow IV Infusion

1. Administered and checked by nurses with Neonatal Drug Certification.
2. A dose concentration of 25 micrograms/ml should be used.  Use either:
   • Paediatric strength ampoule (25 mcg/ml). Do NOT dilute further.
     or
   • Dilute 100 microgram/ml ampoule to 25 microgram/ml:
     Mix 1ml of 100 microgram/ml digoxin with 3ml of sterile water for injection.
3. Filter prior to administration through a 5 micron filter or a Pall filter.
4. Administer by slow IV infusion over 30 minutes using a syringe pump.
5. Compatible with NS, D5W at a 25 micrograms/ml strength.
6. Do NOT mix with other drugs, IV solution, blood or blood products.
7. Continuous cardiac monitoring must be performed while the infusion is in progress and subsequently.
8. Flush line with NS before and after infusion of digoxin.

Oral

1. Can be administered with or without food. Milk does not impair absorption of the drug.
2. Infant Gaviscon has been reported to decrease the amount of digoxin absorbed.

Nursing Considerations

1. Take apex beat for one full minute before administration. Document. Note rate, rhythm and quality. Withhold digoxin and notify doctor immediately if changes are apparent and/or apex rate is <100/min in the preterm infant or <80/min in the term infant. For IV administration continuous cardiac monitoring is essential.
2. Monitor and assess patient response to therapy.
3. Assess for signs of adverse effects and/or toxicity.
4. Monitor for dysrrhythmias, respiratory congestion and peripheral oedema.
5. Weigh daily.
6. Monitor fluid balance.
7. Monitor blood pressure.

Storage

• Ampoules: Store at room temperature <30° C. Protect from light.
• Paediatric elixir: Store at room temperature <25° C. Protect from light.

References