Generic Digoxin

Introduction

Digoxin is a cardiac glycoside used primarily to improve heart function in adults with certain rhythm and contractility disorders. Belonging to the cardiovascular medication group, its active compound is digoxin itself. In the United Kingdom, digoxin is most commonly prescribed for chronic atrial fibrillation (AF) with rapid ventricular response and for symptomatic heart failure with reduced ejection fraction where it augments contractility. While the drug originated from the foxglove plant (Digitalis lanata), modern formulations are synthetic and manufactured to strict pharmaceutical standards. In addition to its principal indications, digoxin can be employed off‑label in certain supraventricular tachycardias under specialist supervision.

What is Digoxin?

Digoxin is the generic version of the original brand “Lanoxin”, containing the same active compound, digoxin. Our online pharmacy provides this generic alternative as a cost‑effective treatment option. It is formulated as film‑coated tablets (.125 mg, .25 mg) and is classified as a cardiac glycoside within the cardiovascular therapeutic class. The drug is produced by several licensed manufacturers whose products are authorised by the UK Medicines and Healthcare products Regulatory Agency (MHRA).

How Digoxin Works

Digoxin exerts its therapeutic effect by inhibiting the sodium‑potassium‑ATPase pump in myocardial cells. This inhibition raises intracellular sodium, which in turn reduces the activity of the sodium‑calcium exchanger. Consequently, calcium is retained within the sarcoplasmic reticulum, increasing the amount released during each contraction. The net result is a positive inotropic effect that strengthens ventricular systolic performance without a proportional rise in oxygen consumption.

In the specialised conduction system, increased vagal tone mediated through the central nervous system shortens the atrioventricular (AV) node refractory period, slowing the ventricular response during AF. The onset of action is typically within 30 minutes after oral administration, while the peak plasma effect appears after 6–8 hours. Digoxin’s elimination half‑life in adults is approximately 36 hours, but varies with renal function because over 70 % of the dose is cleared unchanged by the kidneys. Steady‑state concentrations are therefore achieved after 5–7 days of consistent dosing.

Conditions Treated with Digoxin

• Atrial Fibrillation with rapid ventricular response – By decreasing AV nodal conduction, digoxin controls heart rate and improves exercise tolerance in patients where β‑blockers or calcium‑channel blockers are contraindicated or insufficient.
• Heart failure with reduced ejection fraction (HFrEF) – The positive inotropic action enhances cardiac output, reducing symptoms of fatigue and dyspnoea, especially in patients already on ACE inhibitors, β‑blockers and diuretics.
• Paroxysmal supraventricular tachycardia (PSVT) – In selected cases, digoxin can be used to terminate re‑entrant tachyarrhythmias when electrophysiological intervention is unavailable.

In the UK, epidemiological data from NHS Digital show that atrial fibrillation affects over 300 000 adults over 65 years, and HFrEF prevalence is estimated at 1 % of the adult population. Digoxin therefore remains a relevant therapeutic tool within cardiology practice, particularly where renal function is preserved.

Who is Digoxin For?

Digoxin is most suitable for adult patients who:

• Have symptomatic AF with a resting ventricular rate >100 bpm and require rate control while β‑blockers are contraindicated (e.g., severe asthma) or insufficient.
• Show chronic HFrEF (NYHA class II–III) with left ventricular ejection fraction ≤35 % and are already optimised on guideline‑directed therapy.
• Possess stable renal function (creatinine clearance ≥30 mL/min) because dosage relies heavily on renal excretion.

Clinical scenarios where digoxin is not appropriate include:

• Unstable ventricular rates, marked hypotension, or acute coronary syndrome where a positive inotrope might increase myocardial demand.
• Advanced atrioventricular block or high‑grade sinus node disease without pacing support.
• Severe renal impairment (creatinine clearance <30 mL/min) or dialysis‑dependent patients, where accumulation can precipitate toxicity.

Individual patient factors such as electrolyte balance, age, and concomitant drug regimens must be reviewed before initiation.

Risks, Side Effects, and Interactions

Common adverse events

• Nausea, vomiting, diarrhoea – Gastrointestinal upset is dose‑related and often resolves with dose reduction.
• Visual disturbances – Yellow‑green colour perception (“xanthopsia”) may occur before serious toxicity.
• Fatigue, dizziness – Reflect early signs of sub‑therapeutic or therapeutic concentrations.

Rare adverse events

• Dermatologic rash – May indicate hypersensitivity; discontinuation is advised if persistent.
• Bradyarrhythmia (e.g., sinus bradycardia, AV block) – More likely when combined with β‑blockers or calcium‑channel blockers.

Serious adverse events

• Digoxin toxicity – Characterised by severe arrhythmias (ventricular ectopy, atrial tachycardia with AV block), hyper‑kalaemia, and profound visual changes. Requires immediate medical attention and possible digoxin‑specific antibody therapy.
• Life‑threatening ventricular fibrillation – Particularly in the setting of electrolyte disturbance (low potassium, magnesium).

Clinically relevant drug–drug interactions

• Amiodarone, Quinidine, Verapamil – Reduce digoxin clearance, raising serum levels and risk of toxicity.
• Loop diuretics (Furosemide, Bumetanide) – May cause hypokalaemia, potentiating digoxin’s positive inotropic effect and arrhythmic risk.
• ACE inhibitors, ARBs, NSAIDs – Alter renal perfusion and potassium balance; monitoring is essential.
• Thyroid hormones – Hyperthyroidism increases digoxin clearance, potentially decreasing efficacy.

Patients should disclose all current medications, including over‑the‑counter products and herbal supplements, to avoid harmful interactions.

Practical Use: Dosing, Missed Dose, Overdose

Standard dosing (adult) – For chronic AF, the usual maintenance dose is .125 mg once daily; for HFrEF, initial dosing starts at .125 mg daily and may be titrated up to .25 mg daily according to response and serum concentrations. Renal function dictates dose adjustments; for creatinine clearance 30–50 mL/min, the dose is often halved.

Missed dose – If a dose is forgotten and more than 6 hours have elapsed, it should be taken as soon as remembered, provided the next scheduled dose is at least 8 hours away. Doubling the dose to compensate for a missed tablet is contraindicated due to the narrow therapeutic window.

Overdose – Acute ingestion exceeding 10 mg in an adult is considered a potentially life‑threatening overdose. Immediate actions include:

• Call emergency services (999 in the UK).
• Do not induce vomiting unless directed by a clinician.
• Hospital management often involves activated charcoal, digoxin‑specific antibody fragments (Digibind), and correction of electrolyte abnormalities.

Precautions – Digoxin should be taken with or without food, but consistent timing each day improves steady‑state levels. Avoid excessive alcohol, which can exacerbate bradycardia. Concomitant conditions such as electrolyte disturbances, thyroid disease, or acute infection warrant more frequent plasma level monitoring (.5–.9 µg/L therapeutic window for most adults).

Buying Digoxin from Our Online Pharmacy

Digoxin can be purchased from our online pharmacy in the UK, offering a straightforward route to a verified, cost‑effective product. Our service provides:

• Affordable pricing – Generic digoxin is sourced near manufacturer cost, saving patients up to 60 % compared with branded equivalents.
• Verified quality – All supplies come from MHRA‑approved overseas licensed pharmacies, ensuring compliance with UK safety standards.
• Guaranteed delivery – Discreet, reliable shipping (express service within 7 days for UK addresses, regular airmail taking ~3 weeks for overseas locations).
• Pharmacy broker model – We act as a broker for licensed overseas suppliers, enabling a discreet service that respects patient privacy while maintaining legal import standards.

Our online pharmacy is a safe, cost‑effective option for individuals with limited availability through regular NHS pharmacies or private insurance schemes, providing reliable access to essential cardiovascular therapy.

FAQ

• Is Digoxin available in both brand‑name and generic forms in the UK?
  Yes, Digoxin is marketed as the generic version of the original brand “Lanoxin”. Both forms contain the same active compound, but generic tablets are typically priced lower and are widely prescribed.

• How should Digoxin be stored to maintain potency?
  The tablets should be kept at room temperature (15‑30 °C), protected from direct sunlight, moisture and heat. A dry cabinet or a pantry away from the dishwasher is ideal; no refrigeration is required.

• What does the tablet of Digoxin look like?
  In the UK market, the .125 mg tablets are white, round, film‑coated with “D” imprinted, while the .25 mg tablets are also white but carry a “P” imprint. Inactive ingredients include lactose, magnesium stearate and polymer coating materials.

• Can I travel with Digoxin on an international flight?
  Yes, digoxin can be taken while traveling. Carry the medication in its original packaging, keep a printed copy of the prescription, and store it in your hand luggage to avoid temperature extremes in the hold.

• Are there specific warnings for patients of Asian descent?
  Certain studies suggest a higher prevalence of frailty and lower body mass index among older Asian patients, which may increase susceptibility to digoxin toxicity at standard doses. Dose reductions and careful serum level monitoring are recommended.

• Is there a difference in formulation between EU and US digoxin tablets?
  While the active ingredient is identical, EU formulations often contain lactose, which may be replaced with a hypo‑allergenic filler in the US version. Patients with lactose intolerance should verify the excipient list before use.

• What are the legal requirements for importing digoxin for personal use in the UK?
  Personal import of digoxin for a UK resident is permissible under the Crown import licensing scheme, provided the medication is for personal use, sourced from a licensed overseas pharmacy, and the supply does not exceed three months of treatment.

• How often should therapeutic drug monitoring be performed?
  After initiation, a serum digoxin concentration is usually measured at 6–8 hours for a loading dose and again after 5–7 days once steady state is reached. Routine monitoring is advised every 3–6 months in stable patients, and more frequently after dose changes or in renal impairment.

• Does digoxin interfere with common drug‑testing programmes?
  Digoxin is not a prohibited substance in standard occupational drug‑testing panels, and it does not produce a false‑positive result on typical immunoassay screens. However, specialized cardiac panels can detect therapeutic levels if required.

• Which clinical trial established digoxin’s role in heart failure?
  The Digitalis Investigation Group (DIG) trial, a large multicentre study published in The New England Journal of Medicine (1997), demonstrated that digoxin reduced hospitalisations for heart‑failure exacerbations without increasing mortality, supporting its inclusion in guideline‑directed therapy.

Glossary

Positive inotrope

A drug that increases the force of heart muscle contraction, thereby improving cardiac output.

Therapeutic window

The plasma concentration range in which a medication exerts its intended effect without causing unacceptable toxicity; for digoxin, .5–.9 µg/L.

Renal clearance

The volume of plasma cleared of a drug by the kidneys per unit time, a key factor for digoxin elimination.

AV block

A conduction delay or interruption between the atria and ventricles, which can be exacerbated by digoxin’s vagal effects.

⚠️ Disclaimer

The information provided about Digoxin is for general knowledge only. It does not replace professional medical consultation. All treatment decisions should be made under the supervision of a qualified healthcare provider. We assume all readers are responsible adults capable of making informed decisions about their health. Our online pharmacy offers access to Digoxin for individuals who may have limited availability through traditional pharmacies, prescription‑based insurance schemes, or who are seeking affordable generic alternatives. Always consult your doctor before starting, changing, or discontinuing any medication.