Digoxin IV Push Repetition

Specific Dosing Protocol

• The American College of Cardiology recommends starting with 0.25-0.5 mg IV bolus, with repeat doses of 0.25 mg IV bolus as needed, spaced at 6-8 hour intervals, and not exceeding 1.0 mg total over 24 hours 1, 2, 3
• The maximum loading dose is equivalent to 8-12 mcg/kg, and up to 4 doses of 0.25 mg each can be given within 24 hours before reaching the maximum 1, 2, 3

Critical Dosing Adjustments

• The American College of Cardiology recommends reducing the initial and repeat doses in patients with renal dysfunction, using the lower end of the dosing range (0.125-0.25 mg) 1, 2, 3
• Concurrent amiodarone requires a reduction in digoxin dose by 30-50% 4

Monitoring Between Doses

• The American College of Cardiology recommends assessing for heart rate response, signs of toxicity (nausea, vomiting, visual changes, new arrhythmias), and renal function before giving each repeat dose 1, 2, 3
• Monitoring for signs of toxicity is crucial, as hypokalemia increases toxicity risk, and renal function affects digoxin clearance 1, 2, 3, 5

Absolute Contraindications to Repeat Dosing

• The American College of Cardiology recommends not giving additional doses in patients with AV block greater than first degree without pacemaker, Wolff-Parkinson-White syndrome with atrial fibrillation/flutter, or signs of digoxin toxicity 1, 2, 3