地高辛
Digoxin
別名: Cardoxin · Lanoxin PG · digoxinum · digoxosidum · digitalis
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
小型哺乳類
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Dilated cardiomyopathy in Hamsters | 0.05-0.1 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
雪貂
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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).
鳥
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
馬
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
牛
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
地高辛（Digoxin）是一種強心苷類藥物，主要用於其正性肌力（增加心肌收縮力）和負性變時（降低心率）作用。在獸醫學中，它被用於治療充血性心力衰竭（CHF）和室上性心搏過速，如心房顫動或撲動。
臨床要點：
- 治療指數狹窄： 治療劑量與中毒劑量之間的差距極小。精確的劑量計算和治療藥物監測（TDM）至關重要。
- 治療典範轉移： 雖然過去是治療 CHF 的基石，但由於更安全有效的強心血管擴張劑（如 pimobendan）的出現，地高辛已不再是犬貓心力衰竭的第一線治療藥物。目前主要保留用於心房顫動的心率控制，常與 diltiazem 併用。
- 劑量基準： 由於地高辛不易分佈至脂肪或腹水中，因此必須根據瘦體重（Lean body weight）來計算劑量。
- 物種敏感性： 與犬隻相比，貓對地高辛的毒性高度敏感。
作用機制
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.
安全性與警告
禁忌症
- 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
不良反應
- 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)
注意事項
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.
藥物相互作用
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
監測
- 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)
藥物動力學
半衰期
吸收
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).
分佈
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.
代謝
Metabolized slightly.
排除
Primary method of elimination is renal excretion (both glomerular filtration and tubular secretion). Dosage adjustments are required in significant renal disease.
過量
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.
可用產品
劑型
- 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
獸醫用
- Veterinary-labeled products are no longer available commercially in the USA.
人用標示
- 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
各地核准狀態
POM
POM-V / POM
暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
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.
飼主須知
地高辛是一種強效的心臟藥物，用於幫助心臟更有效地泵血並控制不規律的心跳。
- 嚴格遵照醫囑給藥： 請完全按照獸醫師的指示給藥。未經諮詢獸醫師，請勿自行更改劑量或停藥，因為此藥物的有效劑量與中毒劑量之間的差距非常小。
- 注意中毒跡象： 如果您的寵物出現任何中毒跡象（通常從腸胃不適開始），請立即聯繫獸醫師。請留意食慾不振、嘔吐、腹瀉、嗜睡、抑鬱或行為改變。
- 忘記給藥： 如果忘記給藥，請勿在下次給藥時服用雙倍劑量。請在下一個預定時間給予正常劑量即可。
- 定期監測： 您的寵物需要定期進行血液檢查，以監測血液中的地高辛濃度、腎功能和電解質水平，確保劑量安全有效。
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