European Journal of Clinical Pharmacology

, Volume 18, Issue 1, pp 69–74 | Cite as

Pharmacokinetics and dosage of digoxin in neonates and infants

  • L. Nyberg
  • G. Wettrell


As a therapeutic principle, a disease should be treated with the lowest effective dose of a drug. Accumulating information indicates that satisfactory contractile response of the myocardium is produced in young paediatric patients by doses of digoxin below existing recommendations. In addition, toxicity appears to be more frequent in neonates and infants treated with digoxin than previously thought. Therefore, dose calculations have been performed, based on pharmacokinetic parameters, with the aim of reaching and maintaining an average serum concentration of the glycoside of 2 nmol/l. This level is common in infants (>1 month of age) during digoxin maintenance therapy and its adequacy is well supported by experience from adult cardiac patients.

The calculations show that although current dosage schedules maintain the desired digoxin serum level in infants, they are often excessive for digitalization purposes. In neonates, the prevailing schemes do not sufficiently consider the immature state of the eliminating organs. Overdigitalization could therefore easily occur and continue in these patients, particularly in the premature newborns. This is in agreement with toxicity reports in the literature. The calculated doses should be less hazardous by being better adapted to the eliminating capacity of the various paediatric age-groups.

Key words

digoxin neonates infants pharmacokinetics dosage schedules 


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Copyright information

© Springer-Verlag 1980

Authors and Affiliations

  • L. Nyberg
    • 1
  • G. Wettrell
    • 2
  1. 1.Research and Development DepartmentAB Draco (Subsidiary of AB Astra)LundSweden
  2. 2.Department of PaediatricsKärnsjukhusetSkövdeSweden

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