Toloxin Pediatric (Digoxin) belongs to a class of medications called cardiac glycosides. It is used to treat mild-to-moderate Congestive Heart Failure and to treat certain types of abnormal heart rhythms. It helps to reduce the symptoms of congestive heart failure (e.g., swelling in the ankles, feet, and hands; shortness of breath; frequent fatigue) by helping to increase the strength of the heart so that it pumps more efficiently. Toloxin Pediatric (Digoxin) also helps to maintain a normal heart rhythm in patients with atrial fibrillation.

Toloxin Pediatric (Digoxin) may be available under multiple brand names and/or in several different forms. Any specific brand name of Toloxin Pediatric (Digoxin) may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested Toloxin Pediatric (Digoxin) for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are being given Toloxin Pediatric (Digoxin), speak to your doctor. Do not stop using Toloxin Pediatric (Digoxin) without consulting your doctor.

Do not give Toloxin Pediatric (Digoxin) to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use Toloxin Pediatric (Digoxin) if their doctor has not prescribed it.

The dose varies widely depending on age, disease, weight, and kidney function. Higher doses are often given at the start of treatment to make sure there is enough medication in your body to achieve the desired effect. After this "loading dose", daily adult doses usually range between 0.0625 mg and 0.25 mg. Children's doses are individually determined by their doctor.

Toloxin Pediatric (Digoxin) is normally taken once daily at the same time each day. Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important to take Toloxin Pediatric (Digoxin) exactly as prescribed by your doctor. If you miss a dose, and you remember it within 12 hours, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you miss 2 doses in a row, call your doctor for instruction.

Store Toloxin Pediatric (Digoxin) at room temperature, protect it from light, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes Toloxin Pediatric (Digoxin). If you are concerned about side effects, discuss the risks and benefits of Toloxin Pediatric (Digoxin) with your doctor.

The following side effects have been reported by at least 1% of people taking Toloxin Pediatric (Digoxin). Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• anxiety
• decreased interest in sexual activity
• enlarged breasts (in men)
• dizziness
• headache

• weakness

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• signs of Depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of too much Toloxin Pediatric (Digoxin) in the body:
• abnormal or psychotic behavior
• Diarrhea
• extreme drowsiness or dizziness
• fainting
• loss of appetite
• nausea
• severe headache
• slow heartbeat
• unusually fast heart beat
• vision changes (e.g., yellow-green or blurred vision)
• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)

Infants and children: The signs and symptoms listed above can also occur for infants and children, but heartbeat rate or heart rhythm side effects are more common initially than stomach upset, loss of appetite, changes in vision, or other side effects.

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Tablet

0.0625 mg
Each round, peach, flat-faced, bevelled-edged tablet, debossed "TOLOXIN" over a score line and "06" under it on one side and plain on the other side, contains Toloxin Pediatric (Digoxin) 0.0625 mg (62.5 µg). Nonmedicinal ingredients: FD&C Yellow No. 6, lactose, magnesium stearate, and starch (corn).

0.125 mg
Each round, yellow, flat-faced, bevelled edge tablet, debossed "TOLOXIN" over a score line and "12" under it on one side and plain on the other side, contains Toloxin Pediatric (Digoxin) 0.125 mg (125 µg). Nonmedicinal ingredients: D&C Yellow No. 10, lactose, magnesium stearate, starch (corn), and yellow ferric oxide.

0.25 mg
Each round, white, biconvex tablet, debossed "TOLOXIN" over a score line and "25" under it on one side and plain on the other side, contains Toloxin Pediatric (Digoxin) 0.25 mg (250 µg). Nonmedicinal ingredients: lactose, magnesium stearate, and starch (corn).

Oral solution

0.05 mg/mL

Each mL of clear, light-green coloured liquid with a lime odour and taste contains Toloxin Pediatric (Digoxin) 0.05 mg (50 µg). Nonmedicinal ingredients: alcohol, calcium diatomaceous earth, citric acid, D&C Green No. 5, D&C Yellow No. 10, lime flavour, methylparaben, propylene glycol, sodium phosphate, sucrose, and water. Alcohol: 11.5 mL/100 mL. Tartrazine-free.

Do not take Toloxin Pediatric (Digoxin) if you:

• are allergic to Toloxin Pediatric (Digoxin) or any ingredients of the medication
• have certain abnormal heart rhythms (ventricular fibrillation)

There may be an interaction between Toloxin Pediatric (Digoxin) and any of the following:

Abiraterone acetate Acarbose aminoglycoside antibiotics (e.g., Amikacin, gentamicin, tobramycin) Amiodarone amphetamines antacids anthracycline cancer medications (e.g., Daunorubicin, Doxorubicin) antimalarials (e.g., chloroquine, hydroxychloroquine, Primaquine) antithyroid medications (e.g., Methimazole, Propylthiouracil) Atorvastatin “azole” antifungals (e.g., itraconazole, ketoconazole, Voriconazole) beta-adrenergic blockers (e.g., Acebutolol, Atenolol, Carvedilol, Propranolol, Sotalol, Timolol) boceprevir brimonidine calcium channel blockers (e.g., Diltiazem, Nifedipine, Verapamil) calcium supplements (e.g., calcium carbonate, calcium citrate) certain anticancer medications (e.g., Bleomycin, carmustine) Carbamazepine carvedilol Ceritinib Colestipol Cholestyramine Clonidine Cobicistat Colchicine conivaptan Crizotinib Cyclosporine Dexamethasone Dipyridamole diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene) Donepezil Dronedarone Eplerenone etravirine Fingolimod Flecainide Galantamine glycopyrrolate grapefruit juice Guanfacine HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir) kaolin - pectin Lacosamide

Lapatinib Lenalidomide Levothyroxine licorice Lomitapide macrolide antibiotics (e.g., clarithromycin, erythromycin) Mesalamine methyldopa methyldopa Midodrine mifepristone Mirabegron multivitamins nefazodone neomycin nicardipine Nilotinib non-steroidal anti-inflammatory medications (NSAIDs; e.g., Diclofenac, Ibuprofen, Naproxen) Octreotide Pasireotide penicillamine Phenytoin Polyethylene Glycol 3350 Prazosin primidone Progesterone Propafenone quinidine quinine Regorafenib reserpine rifampin Rivastigmine St. John's wort simeprevir Sitagliptin sodium polystyrene Spironolactone Sucralfate sufentanil Sulfasalazine Sunitinib Tacrolimus Tamoxifen telaprevir Telmisartan Ticagrelor Tizanidine Tolvaptan Trazodone Trimethoprim vitamin D analogues (e.g., alfacalcidol, Calcitriol, cholecalciferol)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Toloxin Pediatric (Digoxin). Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Toloxin Pediatric (Digoxin).

Kidney function: Kidney Disease or reduced kidney function may cause Toloxin Pediatric (Digoxin) to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how Toloxin Pediatric (Digoxin) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Toloxin Pediatric (Digoxin), and whether any special monitoring is needed.

Magnesium levels: Low blood levels of magnesium increase the risk of side effects with Toloxin Pediatric (Digoxin). It is important that magnesium levels be checked periodically when taking Toloxin Pediatric (Digoxin).

Potassium levels: Low blood levels of potassium increase the risk of overdose with Toloxin Pediatric (Digoxin). It is important that potassium levels be checked periodically, especially if you are taking medications that can change the levels of potassium in the blood (e.g., Hydrochlorothiazide, Furosemide).

Potential overdose: The difference between an effective dose and an overdose is less for this medication than for most. Therefore, it is important to take Toloxin Pediatric (Digoxin) exactly as prescribed. If you develop loss of appetite, nausea, or vomiting while taking Toloxin Pediatric (Digoxin), contact your doctor, as these may be signs that the dose is too high.

Thyroid function: The effect of Toloxin Pediatric (Digoxin) on heart rhythm is affected by thyroid function. If you have thyroid disease, discuss with your doctor how Toloxin Pediatric (Digoxin) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Toloxin Pediatric (Digoxin), and whether any special monitoring is needed.

Pregnancy: Toloxin Pediatric (Digoxin) should be taken by pregnant women only if clearly needed. The effects on the developing baby of the mother taking Toloxin Pediatric (Digoxin) during pregnancy are currently unknown.

Breast-feeding: This medication passes into breast milk. It is generally believed that the amount of Toloxin Pediatric (Digoxin) in breast milk that a breast-fed infant would receive is not likely to affect the infant. Talk to your doctor about whether you should continue breast-feeding.

Children: Toloxin Pediatric (Digoxin) can be prescribed to children, however the dose needed by the child changes as the child gets older. Your child’s doctor will want to closely monitor the effectiveness of Toloxin Pediatric (Digoxin) for your child. Keep Toloxin Pediatric (Digoxin) out of the reach of children.

Seniors: As you age, your kidney function can decrease. If this happens you may need a lower dose of Toloxin Pediatric (Digoxin).