Iowa Neonatology Handbook: Pharmocology

Recommended Digoxin Doses in Premature and Full-term Neonates and Infants

1. "Digitalization" is generally used when treating dysrrhythmia. The total loading (digitalizing) dose is administered in three divided doses given every 8 hours. Administer IV slow push over 5 to 10 minutes. Do not administer IM (causes pain and tissue damage). The first maintenance dose should not be given any earlier than 24 hours after the last loading dose in the premature infant and 12 hours in the full-term neonate and infant (1-12 months old).
2. Daily maintenance dose is generally 25% of the digitalizing dose divided into 2 doses. Conversion to oral dosing traditionally involves increasing the intravenous dose by 25 to 30 % because of the assumed bioavailability differences. Whether this dose modification for intravenous to oral administration translates to meaningful pharmacological equivalency in patients is unknown.
3. Dosing the premature infant at 24 hour intervals is based on the prolonged plasma clearance of digoxin. It can be anticipated that renal function will increase sufficiently to require the same recommended dose every 12 hours at approximately one month of age. Measurement of the serum digoxin level will confirm the need for such dosing changes (although in newborns may overestimate injected digoxin levels, because of endogenous digoxin-like substances).
4. Dose should be increased at one month of age to that of the full-term newborn (6 -8 mcg/kg/day). Measurement of the serum digoxin level will confirm the need for such dosing changes.
5. Dose should be increased at one month of age to that of infant (8-12 mcg/kg/day). Measurement of serum digoxin levels will confirm the need for such dosing changes.

References

Preterm - Berman et al (1978), Pinsky et al (1979), Warburton et al (1980), Nyberg and Wettrell (1980), Collins-Nakai (1982b)

Full-Term - Wettrell and Anderson (1977), Nyberg and Wettrell (1980)

Infants - Nyberg and Wettrell (1980)

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