intravenously (drip, jet). In the process of treatment, two periods are distinguished: the period of initial digitalization (saturation) and the period of maintenance therapy.
During the period of initial digitalization, the body becomes gradually saturated with cardiac glycoside until the optimal therapeutic effect is achieved. The individual saturating dose (IDA) is the total dose (taking into account bioavailability and daily elimination), leading to adequate digitalization of the individual patient. The appearance of signs of saturation with glycosides (primarily clinical) means that the patient received an IND.
The therapeutic effect of glycosides is preserved if the body is not less. 80% of the? IND. Exceeding it by 50% usually causes the development of intoxication. The average value of IND in patients without concomitant pathology of the organs responsible for elimination and metabolism is the average saturating dose (SND).This is the dose of cardiac glycoside, at which it is noted, the full therapeutic effect in most patients without the appearance of toxic symptoms.
The maximum - tolerated dose of cardiac glycoside (without intoxication) - the individual maximum tolerated dose may exceed the average saturating dose, coincide with it and be less than SND. IND ranges from 50 to 200% of the average full dose. A significant reduction in the individual maximum tolerated dose occurs in patients with severe myocardial damage and far-reaching decompensation, with myocardial infarction, a "pulmonary" heart. In these patients, signs of intoxication develop earlier than clinical manifestations of positive inotropic action of cardiac glycosides. The digoxin elimination factor is 20%; SND - 3 mg; SPD (average maintenance dose) is 0.6 mg. With moderately fast digitalization
digoxin is administered intravenously. in a daily dose of 0.75 mg in 3 injections. Digitalization is achieved on average 2-3 days.
With slow digitalization, adults are usually administered in a dose of 0.25-0.5 mg (1-2 ml of 0.025% solution) per day. Enter slowly into 10 ml of 5%, 20% or 40% glucose solution or isotonic sodium chloride solution. In the first days of treatment, inject 1-2 times a day, the next - once a day.Digitalization in this case occurs in a week in most patients. Then the patient is transferred to a maintenance dose, which, with IV administration, is usually 0.125-0.25 mg.
Patients with hypersensitivity to cardiac glycosides are given smaller doses and digitize at a slower rate.
When switching from one dosage form to another, the dosage regimen may need to be corrected (different dosage forms have differences in bioavailability). A dose of 100 μg in the form of a solution for injection is bioequivalent to a dose of 125 μg in the form of tablets or an elixir. .
In paroxysmal supraventricular arrhythmias, iv injection, 1-4 ml, 0.025% solution (0.25-1 mg) in 10-20 ml of 20% dextrose solution is administered. For IV injection, the same dose is diluted in 100-200 ml of a 5% solution of dextrose or 0.9%. solution of NaCl. The saturation dose for children is 0.05-0.08 mg / kg; this dose is administered within 3-5 days with moderately rapid digitalization or for 6-7 days with slow digitalization. The maintenance dose for children is 0.01-0.025 mg / kg / day.
If the excretory function of the kidneys is impaired, it is necessary to reduce the dose of digoxin: with KK 50-80 ml / min, SPD is 50% of SPD for persons with normal renal function; with SC less than 10 ml / min - 25% of the usual dose.
CHF: small doses are used up to 0.25 mg / day, for patients with a body weight of more than 85 kg, up to 0.375 mg / day. In elderly ptsints, the daily dose is reduced to 0.0625-0.125 mg.