Digoxin twice a day?

[Libby1987]

We have a patient coming from rehab with a Med list written by the discharging nurse with:

digoxin 6.25mg 1/4 tab 2 X day

digoxin 3.25mg 1/2 tab 2 X day

(I may be mis-remembering the specific dosing)

I've never seen it ordered that way and I asked our nurse to clarify with the MD but is this a thing now?

Hx of Afib and recent CVA.

[AgentBeast, MSN, RN]

That's more like carvedilol dosing. Digoxin is dosed in micrograms (mcg). Maintenance dosing is once a day or once every other day in doses generally up to 250mcg.

6.25mg is 6250mcg 25-50x the typical daily dose and that discharge med list says to that dosage twice a day? I wouldn't give it once.

[Libby1987]

That's more like carvedilol dosing. Digoxin is dosed in micrograms (mcg). Maintenance dosing is once a day or once every other day in doses generally up to 250mcg.

6.25mg is 6250mcg 25-50x the typical daily dose and that discharge med list says to that dosage twice a day? I wouldn't give it once.

Oh geeze, that's why I shouldn't post before coffee, it's mcg.

A pretty small dose for dig. It's the twice daily that has to be wrong, right?

[AgentBeast, MSN, RN]

Digoxin is a maintenance medication there is no point splitting a single daily dosage in half to get two doses per day just like there isn't any point in splitting a patient's 5mg once daily dose of warfarin up into a BID dose of 2.5mg. Depending on why the patient is on digoxin the goal is to establish a blood level of 0.5-0.8ng/mL for CHF patients, and 1.5-2.5ng/mL for a-fib.

[Libby1987]

We got the dose and frequency confirmed.

I had the strengths incorrect upthread but it is a twice daily dose, well documented in additional records and confirmed verbally by MD.

We don't commonly see digoxin at all these and I've never seen it ordered twice a day.