Digoxin maintenance and loading dose (Jusko-Koup)
Population pharmacokinetic digoxin dosing from kidney function, ideal weight, and heart failure status.
Inputs
2 of 8SexUsed by the equation
years
Actual (total) body weight
Stable value
Heart failure
ng/mL
Route
Patient values are shared with every calculator.
When to use
- Starting or adjusting digoxin for heart failure or rate control.
Pearls and pitfalls
- Heart failure target 0.5 to 0.9 ng/mL; higher levels add risk without benefit.
- Loading is rarely needed in heart failure.
- Amiodarone, verapamil, and dronedarone raise levels; reduce the dose by about half.
- Draw levels at least 6 hours after a dose.
Why use
Digoxin is renally cleared with a narrow range; dosing from CrCl prevents toxicity.
CL (mL/min) = 1.303 × CrCl + CLnonrenal (40, or 20 in heart failure); Vd (L) = 3.12 × CrCl + 3.84 × IBW; dose = Css × CL × τ ÷ F