Introduction About DIXIN INJECTION

DIXIN INJECTION contains Digoxin which belongs to the group of medicines called Cardiac glycosides. It is used in the management of arrhythmias (irregular heartbeat, which causes the heart to skip a beat or beat at the wrong speed) and heart failure. Heart failure is a chronic condition where the heart doesn’t pump sufficient blood to other parts of the body, which is generally characterized by symptoms such as shortness of breath, fatigue, weakness, rapid or irregular heartbeat, and swelling in the legs, ankles or feet.  

DIXIN INJECTION is not recommended for use in patients with serious heart problems (such as stokes-Adams attacks (condition where you suddenly feel faint and can pass out due to changes in heart rate) or irregular heartbeat due to cardiac glycoside intoxication) and obstructive cardiomyopathy (disease that causes your heart muscle to enlarge). 

Before receiving DIXIN INJECTION, inform your doctor if you have beri-beri disease (which occurs due to vitamin B1 deficiency), severe lung disease, kidney disorders or liver impairment. Along management with DIXIN INJECTION, your doctor might advise you to take regular blood test to determine the amount of digoxin in your blood and to check the status of the kidney function, especially in patients with kidney disorders.     

DIXIN INJECTION should be used with caution in pregnant and breastfeeding women. Also, it should be used with caution in children and adolescents (below 18 years of age) and in elderly patients (aged 65 years and above).

The most common side effects of receiving DIXIN INJECTION are nausea, vomiting, diarrhea, abnormal heartbeat and dizziness. Consult your doctor if any of the side effect gets worse.   

Uses Of DIXIN INJECTION

Manage:

• arrhythmia
• heart failure

How DIXIN INJECTION Works

DIXIN INJECTION works by increasing the force of contraction of the heart by reversibly inhibiting an enzyme (responsible for controlling the movement of ions into the heart), which leads to correction of irregular heartbeats and strengthening of contraction force, thus helps to manage irregular heartbeat and heart failure.

How to use DIXIN INJECTION

DIXIN INJECTION will be given to you only by a doctor or a nurse into a vein as an intravenous infusion. Your doctor will decide the correct dose and duration for you depending upon your age, body weight and disease condition.

Side Effects Of DIXIN INJECTION

How To Manage Side Effects

Diarrhea

Drink lot of fluids, such as water to keep yourself hydrated. Avoid eating high-fat or spicy foods. Inform your doctor if the symptom gets worse.   

Dizziness Or Drowsiness

Lie down until dizziness is gone, then get up slowly. Move slowly and carefully, do not hurry. Get adequate rest. Drink plenty of water and other fluids. Avoid taking caffeine or its related product. Inform your doctor if the symptom gets worse.

Nausea And Vomiting

Stick to simple meals while receiving this medicine. Avoid eating oily rich, fried or spicy foods. Do not lie down or sleep immediately after eating. Inform your doctor if the symptom does not improve. 

Warning & Precautions

Pregnancy

DIXIN INJECTION should be used with caution during pregnancy. It is also used to manage abnormal increase in the heart rate and congestive heart failure in the unborn child. Consult your doctor before receiving DIXIN INJECTION.      

Breastfeeding

DIXIN INJECTION should be used with caution in breastfeeding women as this medicine gets excreted in small amounts through breastmilk. Consult your doctor before receiving DIXIN INJECTION.      

Driving and Using Machines

Do not drive or operate any machines after receiving DIXIN INJECTION as it may cause dizziness or visual disturbances (such as yellow or blurred vision). 

Kidney

DIXIN INJECTION should be used with caution in patients with kidney disorders. Consult your doctor before receiving DIXIN INJECTION.

Liver

DIXIN INJECTION should be used with caution in patients with hepatic impairment. Consult your doctor before receiving DIXIN INJECTION.

Allergy

Do not receive DIXIN INJECTION if you are allergic to Digoxin or other cardiac glycosides (such as digitoxin) or any other ingredients of this medicine.

Lungs

DIXIN INJECTION should be used with caution in patients with severe respiratory (lung) disease. Consult your doctor before receiving DIXIN INJECTION.

Heart Disease

DIXIN INJECTION is not recommended for use in patients with serious heart problems such as stokes-Adams attacks (condition where you suddenly feel faint and can pass out due to changes in heart rate) or irregular heartbeat (due to cardiac glycoside intoxication/Wolff-Parkinson-white syndrome) and obstructive cardiomyopathy (disease that causes your heart muscle to enlarge). It should be used with caution in patients with heart diseases such as sinoatrial disorder (heart rhythm disorder), recent heart attack, cardiac amyloidosis, myocarditis (inflammation of the heart muscle), constrictive pericarditis (condition where the walls of the fluid-filled pouch around your heart (pericardium) become too stiff or thick), and in patients planned to receive ECG test and electric shock management (to correct abnormal heartbeat). Consult your doctor before receiving DIXIN INJECTION.    

Interactions

A. Drug-Drug interactions:

Before receiving DIXIN INJECTION inform your doctor if you are taking any of the following medicines:

• angiotensin receptor blockers (Ex. telmisartan, irbesartan), angiotensin-converting-enzyme inhibitors (Ex. captopril, enalapril) and nifedipine, verapamil, felodipine, carvedilol, prazosin and diuretics (Ex. chlorothiazide, chlorthalidone) and beta-blockers Ex. atenolol, metoprolol, esmolol (used to manage high blood pressure)
• lithium, nefazodone st. john’s wort, bupropion (used to manage depression)
• corticosteroids (used to provide relief from inflammation) Ex. dexamethasone, hydrocortisone
• carbenoxolone (used to manage digestive tract ulcer)
• other medicines used to manage arrhythmias (Ex. amiodarone, flecainide, propafenone, quinidine, dronedarone)
• canagliflozin, acarbose (used to manage of type 2 diabetes mellitus)
• neomycin, penicillamine, rifampicin, erythromycin, clarithromycin, tetracycline, gentamicin, trimethoprim (antibiotics used to manage bacterial infections)
• telaprevir or daclatasvir, simeprevir, velpatasvir (used with or without other medicines to manage hepatitis C)
• flibanserin (used to manage low sexual desire in women who have not gone through menopause)
• isavuconazole, itraconazole (used to manage fungal infections)
• ivacaftor (used to manage cystic fibrosis)
• spironolactone (medicine used to manage heart failure)
• alprazolam (sedative used to manage anxiety)
• quinine (used to manage malaria infection)
• propantheline (used to manage muscle spasms)
• mirabegron (used to manage overactive bladder) 
• atorvastatin, cholestyramine (used to manage high blood cholesterol)
• cyclosporine (used to manage organ rejection after transplantation)
• epoprostenol (used to manage pulmonary arterial hypertension)
• tolvaptan, conivaptan (used to manage low blood sodium levels)
• ritonavir (used to manage HIV infection)
• ranolazine, tiapamil (used to manage chest pain)
• lapatinib (used to manage breast cancer)
• ticagrelor (used to manage heart attack or stroke)
• vandetanib (used to manage certain cancers of the thyroid gland)
• venetoclax (used to manage patients with chronic lymphocytic leukaemia)
• vemurafenib (used to manage adult patients with a type of cancer called melanoma)
• proton pump inhibitors (PPIs) (used to relieve symptoms of acid reflux) Ex. lansoprazole, omeprazole
• medicine used to manage pain and inflammation such as non-steroidal anti-inflammatory drugs (Ex. ibuprofen, naproxen, indomethacin), and COX-2 inhibitors (Ex. celecoxib, rofecoxib)
• antacids (used to manage gastric acidity) Ex. aluminum hydroxide and magnesium carbonate.
• bulk-forming laxatives (used to manage constipation) Ex. psyllium, polycarbophil
• kaolin-pectin (used to manage diarrhoea)
• cytostatic drugs such as epirubicin, bleomycin (used as chemotherapy for cancer management)
• metoclopramide (used to manage nausea and vomiting)
• sulfasalazine (used to counteract inflammatory diseases of the intestine)
• adrenaline (used to manage severe allergic reactions)
• salbutamol (used to manage asthma)
• phenytoin (used to manage epilepsy)
• supplemental enteral nutrition (used to augment nutrition)
• intravenous calcium (used to manage calcium deficiency)
• sympathomimetics (used to manage heart attack and low blood pressure) Ex. amphetamine, benzylpiperazine
• suxamethonium (used to provide anesthetic effect)

Over dosage:

DIXIN INJECTION will be administered to you only by a doctor or a nurse in a hospital, and so it is unlikely to receive an overdose. However, consult your doctor or nurse if you experience any unusual symptoms while receiving DIXIN INJECTION such as heart rhythm disturbances, gastrointestinal symptoms (such as loss of appetite, nausea and vomiting) dizziness, fatigue, various neurological disturbances including visual disturbances and non-heart related symptoms (such as weakness and general feeling of being unwell).     

Synopsis

More Information

• Store DIXIN INJECTION below 25°C

FAQs About DIXIN INJECTION

What are the common side effects of DIXIN INJECTION?

The most common side effects of receiving DIXIN INJECTION are allergic reactions (signs include skin rash or urticaria), abnormal heartbeat, nausea, vomiting, diarrhea and dizziness. Consult your doctor if any of the side effect gets worse during management with DIXIN INJECTION.

Can DIXIN INJECTION be used in breast-feeding women?

DIXIN INJECTION should be used with caution in breastfeeding women as this medicine gets excreted in small amounts through breastmilk. Consult your doctor before receiving DIXIN INJECTION.

How does DIXIN INJECTION work?

DIXIN INJECTION works by increasing the force of contraction of the heart by reversibly inhibiting an enzyme (responsible for controlling the movement of ions into the heart), which leads to correction of irregular heartbeats and strengthening of contraction force, thus helps to manage irregular heartbeat and heart failure.   

Does DIXIN INJECTION cause diarrhea?

DIXIN INJECTION may cause diarrhea in some individuals. To manage this effect, drink lot of fluids, such as water to keep yourself hydrated. Avoid eating high-fat or spicy foods. Inform your doctor if the symptom gets worse while receiving DIXIN INJECTION.

Is DIXIN INJECTION safe to use in patients with kidney impairment?

DIXIN INJECTION should be used with caution in patients with kidney disorders. Your doctor may adjust the dose based on kidney function to manage any unusual effects. Consult your doctor before receiving DIXIN INJECTION.

References

1. K.D. Tripathi. Cardiac Glycosides and Drugs for Heart Failure. Essentials of medical pharmacology. Seventh edition. 2013. Page 515.

2. Rim Charfi, Mouna Ben Sassi, Emna Gaies, Nadia Jebabli, Riadh Daghfous, Sameh Trabelsi. Digoxin therapeutic drug monitoring: age influence and adverse events. NIH National Library of medicine. National Center for Biotechnology Information. PubMed.gov. [Revised in January 2020] [Accessed on 14th September 2022] https://pubmed.ncbi.nlm.nih.gov/32395775/

3. University Medical Center Groningen. Digoxin Evaluation in Chronic Heart Failure: Investigational Study In Outpatients in the Netherlands (DECISION). NIH U.S. National Library of Medicine ClinicalTrials.gov. [Revised in February 2022] [Accessed on 14th September 2022] https://clinicaltrials.gov/ct2/show/NCT0378342

4. GlaxoSmithKline Manufacturing S.p.A. Electronic Medicines Compendium (EMC). [Revised in April 2022] [Accessed on 14th September 2022] https://www.medicines.org.uk/emc/files/pil.5462.pdf

Useful Diagnostic Tests

• Echocardiogram (ECG)
• Kidney function test