Indications & Dose: ATRIAL FIBRILLATION IV Adult Loading dose: 0.25mg q2h, up to 1.5mg within 24h, MD 0.125-0.375mg/dayrate control in patients with heart failure | HEART FAILURE PO Adult Loading dose not recommended MD 0.125-0.25mg/day, high dose (up to 0.5 mg/day) may be rarely required. In patients with low lean body mass administer 0.125mg q24 or 48h Child Neonate <1.5kg: Initially 25µg/kg in 3 divided doses for 24h, then 4-6µg/kg in 1-2 divided doses, 1.5-2.5 kg: Initially 30µg/kg in 3 divided doses for 24h then 4-6µg/kg in 1-2 divided doses, >2.5 kg: Initially 45µg/kg in 3 divided doses for 24h then 10µg/kg in 1-2 divided doses, 1 month-2 yr: Initially 45µg/kg in 3 divided doses for 24h then 10µg/kg in 1-2 divided doses, 2-5 yr: Initially 35µg/kg in 3 divided doses for 24h then 10µg/kg in 1-2 divided doses, 5-10 yr: Initially 25µg/kg, max 750µg in 3 divided doses for 24h then 6µg/kg/day, max 250µg/kg/day in 1-2 divided doses, 10-18 yr: Initially 0.75-1.5mg in 3 divided doses 24h then 62.5-250µg/day in 1–2 divided doses (higher doses may be necessary) Elderly >70 yr: 0.125mg q24 or 48h | IV Child Neonate <1.5kg: Initially 20µg/kg in 3 divided doses for 24h, then 4-6µg/kg in 1-2 divided doses, 1.5-2.5 kg: Initially 30µg/kg in 3 divided doses for 24h then 4-6µg/kg in 1-2 divided doses, >2.5 kg: Initially 35µg/kg in 3 divided doses for 24h then 10µg/kg in 1-2 divided doses, 1 month-2 yr: Initially 35µg/kg in 3 divided doses for 24h then 10µg/kg in 1-2 divided doses, 2-5 yr: Initially 35µg/kg in 3 divided doses for 24h then 10µg/kg in 1-2 divided doses, 5-10 yr: Initially 25µg/kg, max 500µg in 3 divided doses for 24h then 6µg/kg/day, max 250µg/kg/day in 1-2 divided doses, 10-18 yr: Initially 0. 5-1mg in 3 divided doses 24h then 62.5-250µg/day in 1–2 divided doses (higher doses may be necessary) | Emergency therapy IV Adult 0.5-1mg as single dose given as inf over =>2h, or in divided doses each over 10-20 min | SUPRAVENTRICULAR TACHYARRHYTHMIAS PO Adult Initially total digitalizing dose: 0.75-1.5mg (Give one-half of the total digitalizing dose as the initial dose, then one-quarter of total digitalizing dose in each of 2 subsequent doses at 6-8h intervals), MD 0.125-0.5mg/day | IV Adult Initially total digitalizing dose: 0.5-1mg (Give one-half of the total digitalizing dose as the initial dose, then one-quarter of total digitalizing dose in each of 2 subsequent doses at 6-8h intervals), MD 0.1-0.4mg/day

Precautions: Partial heart block, acute myocarditis, acute MI, advanced HF, severe pulmonary disease, renal impairment, sinus nodal disease, thyroid disease, electrolyte imbalance, strong inducers/inhibitors of P-glycoprotein

ADR: Serious: Accelerated junctional rhythm, atrial tachycardia with/without block, PR prolongation, ventricular tachycardia/ventricular fibrillation, angioneurotic edema, thrombocytopenia, ST segment depression, facial edema, visual disturbances, gynecomastia, Others: sexual dysfunction, diaphoresis, asymmetric chorea, laryngeal edema, nausea, vomiting, diarrhea, pruritus, urticaria, dizziness, mental disturbances, anxiety, confusion, delirium, depression, hallucinations

DDI: Serious Colestipol/Antacids/Colestyramine/Kaolin decreases drug absorption, Rifampicin decreases drug levels, Aspirin/Amiodarone/Ciclosporin/Itraconazole/Nefazodone/NSAIDs/PPIs/Propafenone/Quinidine/Statins/Telmisartan increases drug levels, β-blockers/Disopyramide leads to additive bradycardia, Carbenoxolone/Amphotericin-B/Corticosteroids/Potassium-depleting diuretics/Spironolactone leads to hypokalemia & digitalis toxicity, Reserpine leads to increases incidence of arrhythmias

Diet:

Monitor: HR, rhythm, periodic ECGs, SeCr, serum electrolyte levels, noncardiac signs of toxicity, confusion & depression