ACYLANID
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ACYLANID (ACYLANID).
Acylanid is a cardiac glycoside that inhibits the Na+/K+-ATPase pump, leading to increased intracellular sodium and calcium concentrations, which enhances myocardial contractility.
| Metabolism | Hepatic metabolism via hydrolysis and conjugation; not significantly metabolized by CYP enzymes. |
| Excretion | Renal (≈70% as unchanged drug), biliary/fecal (≈30%) |
| Half-life | Terminal half-life 33–36 hours (anuric patients up to 110 hours); requires dose adjustment in renal impairment. |
| Protein binding | 25–30% bound to albumin. |
| Volume of Distribution | 7.5–10 L/kg; wide distribution indicating extensive tissue binding. |
| Bioavailability | Oral: 70–85% (variable, dependent on gastrointestinal absorption). |
| Onset of Action | Oral: 1–2 hours; IV: 10–30 minutes. |
| Duration of Action | Oral: 6–8 days (cumulative effect); IV: 3–5 days. |
0.1 mg IV bolus over 5 minutes, followed by 0.1 mg IV after 1 hour if needed; then 0.1-0.2 mg orally every 6-8 hours for maintenance. Maximum cumulative dose: 0.4 mg IV.
| Dosage form | TABLET |
| Renal impairment | GFR <30 mL/min: reduce dose by 50% and extend dosing interval to every 12-24 hours. GFR 30-50 mL/min: consider 25% dose reduction. Monitor digoxin levels. |
| Liver impairment | Child-Pugh Class B: reduce dose by 25-50%. Child-Pugh Class C: use with caution, reduce dose by 50% and monitor levels. Not recommended in severe hepatic impairment. |
| Pediatric use | Loading dose: 10-15 mcg/kg IV over 5 minutes. Maintenance: 5-10 mcg/kg orally every 8-12 hours. Maximum daily dose: 250 mcg in children <2 years, 500 mcg in older children. |
| Geriatric use | Initiate with 50% of usual adult dose due to reduced renal function and increased sensitivity. Maximum loading dose: 0.2 mg IV. Maintenance: 0.1 mg every 12 hours. Monitor electrolytes and ECG. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for ACYLANID (ACYLANID).
| Breastfeeding | Acylanid is excreted into breast milk in low amounts (M/P ratio not established; estimated <1% of maternal dose). No adverse effects reported in nursing infants. Use with caution, monitor infant for bradycardia or arrhythmias. |
| Teratogenic Risk | Acylanid is a cardiac glycoside with limited data in pregnancy. First trimester: No specific malformations reported, but potential for fetal cardiac effects due to mechanism. Second and third trimesters: Maternal toxicity (arrhythmias, electrolyte disturbances) may cause fetal hypoxia or growth restriction. Avoid toxicity. Category C. |
■ FDA Black Box Warning
None.
| Serious Effects |
["Ventricular fibrillation","Hypersensitivity to cardiac glycosides","Digitalis toxicity"]
| Precautions | Risk of digitalis toxicity; monitor renal function and electrolytes; caution in hypokalemia, hypomagnesemia, and hypercalcemia. |
| Food/Dietary | Avoid high-potassium foods (bananas, oranges, spinach) unless directed; hypokalemia increases toxicity. Take with food to reduce GI upset. Do not take with high-fiber meals as may reduce absorption. |
| Clinical Pearls |
Loading safety data…
| Fetal Monitoring | Monitor maternal serum drug levels, heart rate, ECG, potassium, magnesium, calcium. Fetal: ultrasound for growth and amniotic fluid; fetal heart rate monitoring in third trimester. |
| Fertility Effects | No known adverse effects on fertility in males or females based on available data. |
| Acylanid (lanatoside C) is a digitalis glycoside with rapid onset (IV 10-30 min) and moderate duration; use in atrial fibrillation with rapid ventricular response, especially in acute settings. Monitor renal function due to renal elimination; toxicity risk increases with hypokalemia, hypomagnesemia, hypercalcemia. Adjust dose in renal impairment (CrCl <50 mL/min). Therapeutic drug monitoring: target serum level 0.5-2 ng/mL (drawn >6-8 hours post-dose). |
| Patient Advice | Take exactly as prescribed; do not skip doses or double up. Missed dose: take if within 12 hours, otherwise skip. · Monitor for signs of toxicity: nausea, vomiting, diarrhea, visual disturbances (yellow-green halos, blurred vision), confusion, irregular heartbeat. · Avoid OTC medications without consulting prescriber, especially antacids, laxatives, and antiarrhythmics. · Keep regular appointments for blood tests (digoxin level, kidney function, electrolytes). · Report weight gain >2 lbs/day, swelling, shortness of breath, or palpitations. |