디고신
Digoxin
다른 이름: Cardoxin · Lanoxin PG · digoxinum · digoxosidum · digitalis
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| CHF with atrial fibrillation in dogs with normal renal function | 0.005-0.0075 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
| Initial dosing for dogs weighing less than 20 kg | 0.005-0.011 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
| Initial dosing for dogs weighing more than 20 kg | 0.22 mg/m2 (NOT mg/kg) PO q12h | PO | q12h | — | 🌎 NA |
| Adjunctive treatment of dilated cardiomyopathy patients with atrial fibrillation | 0.0025 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
| Adjunctive treatment of atrial fibrillation | 0.003-0.005 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
| Refractory heart failure or atrial fibrillation (if pimobendan unavailable) | 0.005 mg/kg PO twice a day | PO | q12h | — | 🌎 NA |
| Supraventricular arrhythmias | 0.22 mg/m2 (NOT mg/kg) PO q12h | PO | q12h | — | 🌎 NA |
| Management of supraventricular tachyarrhythmias | 2.5-3.5 μg/kg (based on lean body weight; decrease dose by 10% for elixir). Maximum dose 0.25 mg/dog. Start at lower end of dose range and up-titrate carefully. | PO | q12h | Long-term | 🌍 EU |
| Management of supraventricular tachyarrhythmias (Emergency/Rare) | 2.2-4.4 μg/kg | IV | q12h | As needed | 🌍 EU |
- CHF with atrial fibrillation in dogs with normal renal function: Trough level of 0.8-1.2 nanograms/mL is the recommended target.
- Initial dosing for dogs weighing less than 20 kg: Results in therapeutic range by second day. Monitor levels 3-5 days later.
- Initial dosing for dogs weighing more than 20 kg: Results in therapeutic range by second day. Monitor levels 3-5 days later.
- Adjunctive treatment of dilated cardiomyopathy patients with atrial fibrillation: Loading dose usually not given. Trough therapeutic level is 0.8-1.2 ng/mL.
- Refractory heart failure or atrial fibrillation (if pimobendan unavailable): Start with a low dose and round down if needed.
- Management of supraventricular tachyarrhythmias: Dose based on lean body weight. Decrease dose by 10% for elixir.
- Management of supraventricular tachyarrhythmias (Emergency/Rare): Only use IV if essentially indicated. Administer very slowly.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Dilated cardiomyopathy or advanced atrioventricular valve insufficiency | 0.007 mg/kg PO every other day | PO | q48h | — | 🌎 NA |
| Starting dose for normal cats weighing less than 3 kg | 1/4th of a 0.125 mg tablet administered every other day | PO | q48h | — | 🌎 NA |
| Starting dose for normal cats weighing 3 to 6 kg | 1/4th of a tablet every day | PO | q24h | — | 🌎 NA |
| Starting dose for normal cats weighing more than 6 kg | 1/4th of a tablet every day to q12h | PO | q12h-q24h | — | 🌎 NA |
| Management of supraventricular tachyarrhythmias | 10 μg/kg (equating to 1/4 of a 125 μg tablet). Start at lower dose range and titrate up. | PO | q24-48h | Long-term | 🌍 EU |
| Management of supraventricular tachyarrhythmias (Emergency/Rare) | 1-1.6 μg/kg | IV | q12h | As needed | 🌍 EU |
- Dilated cardiomyopathy or advanced atrioventricular valve insufficiency: Use lean body weight. Measure serum level 10+ days later, 8-10 hours after dosing. Therapeutic level: 1-2 ng/mL.
- Starting dose for normal cats weighing less than 3 kg: Tablets are better tolerated than the alcohol-based elixir.
- Starting dose for normal cats weighing 3 to 6 kg: Using 0.125 mg tablet.
- Starting dose for normal cats weighing more than 6 kg: Using 0.125 mg tablet.
- Management of supraventricular tachyarrhythmias: Cats are highly sensitive to toxicity.
- Management of supraventricular tachyarrhythmias (Emergency/Rare): Only use IV if essentially indicated. Administer very slowly.
소형 포유류
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Dilated cardiomyopathy in Hamsters | 0.05-0.1 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
페렛
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Dilated cardiomyopathy | 0.01 mg/kg PO once daily initially | PO | q24h | — | 🌎 NA |
| Maintenance | 0.005-0.01 mg/kg PO once to twice daily | PO | q12h-q24h | — | 🌎 NA |
| Dilated cardiomyopathy long-term maintenance | 0.01 mg/kg q24h | PO | q24h | Long-term | 🌎 NA |
- Dilated cardiomyopathy: Use oral liquid. May increase to twice daily if necessary.
- Maintenance: Using the elixir; monitor blood levels if possible.
- Dilated cardiomyopathy long-term maintenance: Used with furosemide (2 mg/kg q12h) and enalapril (0.5 mg/kg q48h).
새
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Emergency stabilization | 0.02-0.5 mg/kg q12h for 2-3 days, then decreased to 0.01 mg/kg q12-24h | PO/IM/IV | q12h then q12-24h | 2-3 days initial, then maintenance | 🌎 NA |
- Emergency stabilization: Because of very small therapeutic margin, best used for emergency stabilization rather than long-term therapy. Consider switching to an ACE inhibitor.
말
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Loading dose | 11 micrograms/kg IV given slowly or in divided doses, or 44 micrograms/kg PO | IV/PO | Once | — | 🌎 NA |
| Maintenance Dose | 2.2 micrograms/kg IV every 12h or 11 micrograms/kg PO every 12 hours | IV/PO | q12h | — | 🌎 NA |
- Loading dose: ARCI UCGFS Class 4 Drug
- Maintenance Dose: Maintain plasma concentrations between 0.5-2 ng/mL.
소
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Normalize atrial rate | 0.25 mg/100 lbs body weight | PO | Titrate to effect | — | 🌎 NA |
- Normalize atrial rate: Not destroyed in rumen; not excreted in milk.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
디고신은 주로 양성 변력 작용(심근 수축력 증가) 및 음성 변시 작용(심박수 감소)을 위해 사용되는 강심배당체입니다. 수의학에서는 울혈성 심부전(CHF) 및 심방세동이나 조동과 같은 상심실성 빈맥 치료에 사용됩니다.
임상 요점:
- 좁은 치료 지수: 치료 용량과 독성 용량 사이의 차이가 매우 작습니다. 신중한 용량 설정과 치료 약물 농도 모니터링(TDM)이 필수적입니다.
- 치료 패러다임의 변화: 역사적으로 CHF 관리의 핵심이었으나, 피모벤단과 같이 더 안전하고 효과적인 약물의 등장으로 더 이상 개와 고양이의 심부전 1차 치료제로 간주되지 않습니다. 현재는 주로 심방세동의 심박수 조절을 위해 딜티아젬과 함께 보조적으로 사용됩니다.
- 용량 기준: 디고신은 지방이나 복수로 잘 분포되지 않으므로 반드시 제지방 체중(Lean body weight)을 기준으로 용량을 설정해야 합니다.
- 종 특이적 민감도: 고양이는 개에 비해 디고신 독성에 매우 민감합니다.
작용 기전
Digoxin exerts its effects through the reversible inhibition of the Na⁺/K⁺-ATPase pump in the myocardial cell membrane.
- Positive Inotropy (Contractility): Inhibition of Na⁺/K⁺-ATPase → Increased intracellular Na⁺ → Decreased driving force for the Na⁺/Ca²⁺ exchanger (NCX) → Decreased Ca²⁺ extrusion → Increased intracellular Ca²⁺ → Increased Ca²⁺ uptake into the sarcoplasmic reticulum. Upon the next action potential, more Ca²⁺ is released, leading to increased myocardial contractility.
- Negative Chronotropy/Dromotropy (Heart Rate/Conduction): Digoxin increases vagal (parasympathetic) tone → Decreased conduction velocity through the AV node and prolonged effective refractory period (ERP) → Slowed ventricular response rate in supraventricular arrhythmias.
- Neurohormonal Effects: At low doses, digoxin restores baroreceptor sensitivity, which decreases sympathetic outflow and reduces the neurohormonal activation seen in heart failure.
안전성·주의사항
금기사항
- Ventricular fibrillation
- Digitalis intoxication
- Hypertrophic cardiomyopathy in cats (relative contraindication, may increase myocardial oxygen demand and dynamic outflow obstruction)
- Frequent ventricular arrhythmias
- Atrioventricular (AV) block
- Feline hypertrophic cardiomyopathy
- Hypokalaemia
부작용
- Cardiac arrhythmias (complete or incomplete heart block, bigeminy, ST segment changes, paroxysmal ventricular or atrial tachycardias, multifocal VPCs)
- Mild GI upset
- Anorexia
- Weight loss
- Diarrhea
- Vomiting (especially associated with IV injections)
- Diarrhoea
- Depression
- Arrhythmias (AV block, bigeminy, paroxysmal ventricular or atrial tachycardias with block, multiform VPCs)
- Vasoconstriction (with IV administration)
주의
Extreme Caution: Patients with glomerulonephritis and heart failure, or with idiopathic hypertrophic subaortic stenosis (IHSS).
- Caution: Severe pulmonary disease, hypoxia, acute myocarditis, myxedema, acute myocardial infarction, frequent VPCs, V-tach, chronic constrictive pericarditis, or incomplete AV block.
- Renal Disease: Principally eliminated by the kidneys; use with caution and monitor serum levels closely in patients with renal impairment.
- Electrolyte/Endocrine Imbalances: Animals that are hypernatremic, hypokalemic, hypercalcemic, hyper- or hypothyroid may require smaller dosages; monitor carefully.
- Cardioversion: Elective cardioversion of patients with atrial fibrillation should be postponed until digoxin has been withheld for 1-2 days.
- Dosing Weight: Dosing is generally based upon lean body weight as digoxin does not distribute well into ascitic fluid or fat.
약물 상호작용
May reduce digoxin serum levels
May reduce digoxin serum levels
May reduce digoxin serum levels in dogs
May reduce digoxin serum levels
May reduce digoxin serum levels
May reduce digoxin serum levels
May reduce digoxin serum levels
May reduce digoxin serum levels
May reduce digoxin serum levels
May reduce digoxin serum levels
May reduce digoxin serum levels
May increase serum levels, decrease elimination rate, or enhance toxic effects
May increase serum levels, decrease elimination rate, or enhance toxic effects
May increase serum levels, decrease elimination rate, or enhance toxic effects
May increase serum levels, decrease elimination rate, or enhance toxic effects
May increase serum levels, decrease elimination rate, or enhance toxic effects
May increase serum levels, decrease elimination rate, or enhance toxic effects
May increase serum levels (data conflicts); additive negative effects on AV conduction
May increase serum levels, decrease elimination rate, or enhance toxic effects
May increase serum levels, decrease elimination rate, or enhance toxic effects; hypokalemia predisposes to digitalis toxicity
May increase serum levels, decrease elimination rate, or enhance toxic effects
May increase serum levels, decrease elimination rate, or enhance toxic effects
May increase serum levels, decrease elimination rate, or enhance toxic effects
May increase serum levels; rule of thumb is to decrease digoxin dose by 50% if used together
May increase serum levels, decrease elimination rate, or enhance toxic effects
May increase serum levels, decrease elimination rate, or enhance toxic effects
May increase serum levels, decrease elimination rate, or enhance toxic effects
May increase serum levels; additive negative effects on AV conduction
Additive negative effects on AV conduction, complete heart block possible
May decrease serum levels of digoxin independent of route of digoxin dosing
May predispose the patient to digitalis toxicity via electrolyte imbalances (e.g., hypokalemia)
May enhance or decrease the toxic effects of digoxin
Patients on digoxin that receive thyroid replacement therapy may need their digoxin dosage adjusted
May decrease digoxin absorption from the GI tract
May increase serum level, decrease elimination rate, or enhance toxic effects
Can cause hypokalaemia, which strongly predisposes to digoxin toxicity
May increase serum level, decrease elimination rate, or enhance toxic effects
May decrease digoxin absorption from the GI tract
May decrease digoxin absorption from the GI tract
May decrease digoxin absorption from the GI tract
May decrease digoxin absorption from the GI tract
May cause hypokalaemia, which enhances the toxic effects of digoxin
May cause hypokalaemia, which enhances the toxic effects of digoxin
모니터링
- Serum digoxin levels (Trough levels recommended: Dogs 0.8-1.2 ng/mL; Cats 0.9-2 ng/mL; Other species 0.5-2 ng/mL. Wait at least 6 days after starting therapy to reach steady-state)
- Appetite and body weight
- Cardiac rate and ECG changes
- Serum electrolytes (especially potassium)
- Renal function tests
- Clinical efficacy for CHF (improved perfusion, decreased edema)
- Serum digoxin levels (check after 7-10 days, sample taken 6-8 hours post-pill. Ideal trough therapeutic level: 0.6-1.2 ng/ml)
- ECG (monitor for AV block and ventricular arrhythmias)
- Serum potassium levels (hypokalaemia increases toxicity risk)
- Renal function (BUN, Creatinine)
약동학
반감기
흡수
Variable depending on the oral dosage form. Food may delay, but not alter, the extent of absorption in most species. In cats, food reportedly decreases the amount absorbed by 50% after tablet administration. Peak serum levels occur within 45-60 minutes (elixir) and 90 minutes (tablet).
분포
Widely distributed with highest levels in kidneys, heart, intestine, stomach, liver, and skeletal muscle. Lowest concentrations in brain and plasma. Does not significantly enter ascitic fluid. Approximately 20-30% bound to plasma proteins.
대사
Metabolized slightly.
배설
Primary method of elimination is renal excretion (both glomerular filtration and tubular secretion). Dosage adjustments are required in significant renal disease.
과다투여
Acute Toxicity: In dogs, the acute toxic dose after IV administration is reported to be 0.177 mg/kg.
Treatment of Toxicity:
- Chronic Toxicity: Often resolves by temporarily stopping the drug and reevaluating the dosage regimen.
- Acute Ingestion: If recent and no cardiotoxic/neurologic signs are present, empty the stomach followed by activated charcoal. Repeated charcoal administration may be beneficial due to enterohepatic recirculation. Anion-exchange resins (colestipol, cholestyramine) can reduce absorption but are rarely available.
- Supportive Care: Continuous ECG monitoring, correct acid-base/hypoxia/fluid/electrolyte imbalances. Note: Potassium use in normokalemic patients is controversial and requires expertise.
- Antiarrhythmics: Lidocaine and phenytoin are commonly used for life-threatening digitalis-induced arrhythmias. Atropine may treat sinus bradycardia, SA arrest, or AV block.
- Antidote: Digoxin immune Fab (ovine antibodies) binds directly to the drug, inactivating it. It is highly effective but very expensive, and veterinary experience is limited.
제품
제형
- Injection
- Tablets
- Oral Solution
- 62.5 μg oral tablet
- 125 μg oral tablet
- 250 μg oral tablet
- 50 μg/ml oral elixir
- 250 μg/ml injectable
동물용의약품
- Veterinary-labeled products are no longer available commercially in the USA.
인용의약품
- Digoxin Solution for Injection: 250 micrograms/mL (0.25 mg/mL) and 100 micrograms/mL (0.1 mg/mL) (Lanoxin, generic)
- Digoxin Oral Tablets: 125 micrograms (0.125 mg) and 250 micrograms (0.25 mg) (Lanoxin, generic)
- Digoxin Oral Solution: 50 micrograms/mL (0.05 mg/mL) (generic)
- Lanoxin 62.5 μg, 125 μg, 250 μg tablets
- Lanoxin PG 50 μg/ml elixir
- Lanoxin 250 μg/ml injectable
규제 현황
POM
POM-V / POM
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Store tablets, capsules, elixir, and injection at room temperature (15-30°C) and protect from light. Stable at pH 5-8; hydrolyzed in solutions with a pH of less than 3.
보호자 정보
디고신은 심장이 더 효과적으로 혈액을 펌프질하도록 돕고 불규칙한 심장 박동을 조절하는 데 사용되는 강력한 심장약입니다.
- 정확한 투약: 처방된 대로 정확하게 약을 투여하십시오. 도움이 되는 용량과 독성을 일으키는 용량의 차이가 매우 작으므로, 수의사와 상의 없이 용량을 변경하거나 약을 중단하지 마십시오.
- 독성 징후 관찰: 반려동물에게 독성 징후(보통 위장관 문제로 시작됨)가 나타나면 즉시 수의사에게 연락하십시오. 식욕 부진, 구토, 설사, 무기력, 우울증 또는 행동 변화가 있는지 주의 깊게 살펴보십시오.
- 투약 누락 시: 약을 먹이는 것을 잊은 경우, 다음 번에 두 배의 용량을 먹이지 마십시오. 다음 예정된 시간에 정해진 용량만 투여하십시오.
- 정기적인 모니터링: 약물 용량이 안전하고 효과적인지 확인하기 위해 혈중 디고신 농도, 신장 기능 및 전해질 수치를 확인하는 정기적인 혈액 검사가 필요합니다.
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