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Buy Digoxin Online __EXCLUSIVE__

HOW TO USE: Take this medication by mouth with or without food, usually once daily or as directed by your doctor. If you are using the liquid form of this medication, carefully measure the dose using the dropper provided by the manufacturer. Do not use a household spoon because you may not get the correct dose. Your body may not absorb this drug as well if you also eat foods that are high in fiber or if you take certain medications. Therefore, take this medication at least 2 hours before or after eating food products that are high in fiber (such as bran). If you are also taking cholestyramine, colestipol, or psyllium, wait at least 2 hours after taking your digoxin dose before taking any of these products. If you are taking antacids, kaolin-pectin, milk of magnesia, metoclopramide, sulfasalazine, or aminosalicylic acid, take them as far apart from your digoxin dose as possible. Ask your pharmacist if you are not sure when to take any of your medications. The dosage of this medication is based on your medical condition, age, body weight, and response to treatment. Use this medication regularly to get the most benefit from it. To help you remember, use it at the same time each day. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Tell your doctor if your condition does not improve or if it worsens.

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PRECAUTIONS: Before taking digoxin, tell your doctor or pharmacist if you are allergic to it; or to similar drugs (such as digitoxin); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney problems, thyroid problems (underactive or overactive). The balance of certain natural minerals in your blood (calcium, magnesium, potassium) can affect how this drug works in your body. Certain drugs such as "water pills" (diuretics) may affect the normal balance of these minerals. Tell your doctor or pharmacist if you are taking a "water pill" or if you have a history of mineral imbalance. Ask your doctor or pharmacist whether you should take a nutritional supplement or follow a special diet. Before having surgery or certain procedures on your heart (such as electrical cardioversion), tell your doctor or dentist that you are using this medication. Infants and children may be more sensitive to the effects of this drug, especially the effects on the heartbeat. During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor. Digoxin passes into breast milk. While there have been no reports of harm to nursing infants, consult your doctor before breast-feeding.

DRUG INTERACTIONS: See also How to Use section. Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first. Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use. Other medications can affect the removal of digoxin from your body, which may affect how digoxin works. Examples include amiodarone, azole antifungals (such as itraconazole, ketoconazole), cyclosporine, lapatinib, macrolide antibiotics (such as clarithromycin, erythromycin), propafenone, ranolazine, rifampin, St. John's wort, among others. Check the labels on all your medicines (such as cough-and-cold products, diet aids, or NSAIDs such as ibuprofen, naproxen) because they may contain ingredients that could worsen your heart failure. Ask your pharmacist for more details. This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

NOTES: Do not share this medication with others. Laboratory and/or medical tests (such as digoxin levels, mineral levels in the blood, kidney function tests, electrocardiograms) should be performed periodically to monitor your progress or check for side effects. Keep all regular medical and laboratory appointments. Learn how to check your pulse, and share the results with your doctor. Consult your doctor for more details.

Digoxin is a positive inotropic and negative chronotropic drug7, meaning that it increases the force of the heartbeat and decreases the heart rate.23 The decrease in heart rate is particularly useful in cases of atrial fibrillation, a condition characterized by a fast and irregular heartbeat.13 The relief of heart failure symptoms during digoxin therapy has been demonstrated in clinical studies by increased exercise capacity and reduced hospitalization due to heart failure and reduced heart failure-related emergency medical visits.25 Digoxin has a narrow therapeutic window.25

Digoxin poses a risk of rapid ventricular response that can cause ventricular fibrillation in patients with an accessory atrioventricular (AV) pathway. Cardiac arrest as a result of ventricular fibrillation is fatal.25 An increased risk of fatal severe or complete heart block is present in individuals with pre-existing sinus node disease and AV block who take digoxin.25

Digoxin exerts hemodynamic, electrophysiologic, and neurohormonal effects on the cardiovascular system.7 It reversibly inhibits the Na-K ATPase enzyme, leading to various beneficial effects. The Na-K ATPase enzyme functions to maintain the intracellular environment by regulating the entry and exit of sodium, potassium, and calcium (indirectly). Na-K ATPase is also known as the sodium pump25. The inhibition of the sodium pump by digoxin increases intracellular sodium and increases the calcium level in the myocardial cells, causing an increased contractile force of the heart.25,11 This improves the left ventricular ejection fraction (EF), an important measure of cardiac function.7,22

An oral dose of digoxin may be transformed into pharmacologically inactive products by bacteria in the colon. Studies have indicated that 10% of patients receiving digoxin tablets will experience the degradation of at least 40% of an ingested dose of digoxin by gut bacteria. Several antibiotics may increase the absorption of digoxin in these patients, due to the elimination of gut bacteria, which normally cause digoxin degradation.25

Patients with malabsorption due to a variety of causes may have a decreased ability to absorb digoxin.25 P-glycoprotein, located on cells in the intestine, may interfere with digoxin pharmacokinetics, as it is a substrate of this efflux transporter. P-glycoprotein can be induced by other drugs, therefore reducing the effects of digoxin by increasing its efflux in the intestine.25

This drug is widely distributed in the body, and is known to cross the blood-brain barrier and the placenta.25,6 The apparent volume of distribution of digoxin is 475-500 L.25 A large portion of digoxin is distributed in the skeletal muscle followed by the heart and kidneys.6 It is important to note that the elderly population, generally having a decreased muscle mass, may show a lower volume of digoxin distribution.25

About 13% of a digoxin dose is found to be metabolized in healthy subjects. Several urinary metabolites of digoxin exist, including dihydrodigoxin and digoxigenin bisdigitoxoside. Their glucuronidated and sulfated conjugates are thought to be produced through the process of hydrolysis, oxidation, and additionally, conjugation. The cytochrome P-450 system does not play a major role in digoxin metabolism, nor does this drug induce or inhibit the enzymes in this system.25

The elimination of digoxin is proportional to the total dose, following first order kinetics. After intravenous (IV) administration to healthy subjects, 50-70% of the dose is measured excreted as unchanged digoxin in the urine. Approximately 25 to 28% of digoxin is eliminated outside of the kidney. Biliary excretion appears to be of much less importance than renal excretion.6

Digoxin has a half-life of 1.5-2 days in healthy subjects.25 The half-life in patients who do not pass urine, usually due to renal failure, is prolonged to 3.5-5 days. Since most of the drug is distributed extravascularly, dialysis and exchange transfusion are not optimal methods for the removal of digoxin.25

The clearance of digoxin closely correlates to creatinine clearance, and does not depend on urinary flow. Individuals with renal impairment or failure may exhibit extensively prolonged half-lives. It is therefore important to titrate the dose accordingly and regularly monitor serum digoxin levels.25 One pharmacokinetic study measured the mean body clearance of intravenous digoxin to be 88 44ml/min/l.73 m.16 Another study provided mean clearance values of 53 ml/min/1.73 m in men aged 73-81 and 83 ml/min/1.73 m in men aged 20-33 years old after an intravenous digoxin dose.15

Digoxin toxicity can occur in cases of supratherapeutic dose ingestion or as a result of chronic overexposure.20 Digoxin toxicity may be manifested by symptoms of nausea, vomiting, visual changes, in addition to arrhythmia. Older age, lower body weight, and decreased renal function or electrolyte abnormalities lead to an increased risk of digoxin toxicity.25

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Because the difference between the treatment dose and the dose that causes side effects is small, do not adjust the medication without contacting your veterinarian. Contact your veterinarian if your pet shows decreased appetite, vomiting, diarrhea, incoordination, changes in urination, or weakness while being treated with digoxin. 041b061a72

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