CEDILANID-D
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CEDILANID-D (CEDILANID-D).
Digitalis glycoside; inhibits Na+/K+-ATPase, increasing intracellular calcium and cardiac contractility.
| Metabolism | Hepatic (minor); primarily renally excreted unchanged. |
| Excretion | Renal excretion of unchanged drug accounts for 60-70% of elimination; biliary/fecal excretion accounts for 30-40%, with enterohepatic circulation present. |
| Half-life | Terminal elimination half-life is 36-48 hours in patients with normal renal function; prolonged to >100 hours in severe renal impairment, requiring dose adjustment. |
| Protein binding | 25-30% bound to plasma albumin. |
| Volume of Distribution | 6-10 L/kg; large Vd indicates extensive tissue distribution and high cardiac tissue affinity. |
| Bioavailability | Oral: 70-80%; IV: 100%. |
| Onset of Action | Oral: 30-60 minutes; IV: 5-30 minutes. |
| Duration of Action | Oral: 6-8 hours for initial effect, but digitalizing effect persists 3-6 days due to tissue binding; IV: similar duration. |
0.05 to 0.2 mg intravenously or intramuscularly, administered slowly over 5 minutes; initial dose 0.15 to 0.2 mg, then 0.1 to 0.15 mg every 30 minutes up to a total of 0.4 mg. Oral: 0.05 to 0.2 mg daily for maintenance.
| Dosage form | INJECTABLE |
| Renal impairment | GFR <50 mL/min: reduce dose by 50% or extend dosing interval to every 36-48 hours. GFR <10 mL/min: avoid use or reduce dose by 75%. |
| Liver impairment | Child-Pugh Class A: no adjustment. Child-Pugh Class B: reduce dose by 25-50%. Child-Pugh Class C: avoid use or reduce dose by 75%. |
| Pediatric use | Digitalizing dose: 0.01-0.02 mg/kg IV or IM, given in divided doses over 24 hours. Maintenance: 10-20% of digitalizing dose daily. Not recommended for neonates due to prolonged half-life. |
| Geriatric use | Reduce dose by 25-50% due to decreased renal function and increased sensitivity. Monitor serum levels and renal function closely. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CEDILANID-D (CEDILANID-D).
| Breastfeeding | Deslanoside is excreted in breast milk; estimated infant dose 0.1-0.5% of maternal weight-adjusted dose; M/P ratio not well defined. Monitor infant for bradycardia, feeding difficulties; benefit likely outweighs risk. |
| Teratogenic Risk | Pregnancy Category C. First trimester: No adequate human studies; animal studies show fetal risk. Second/third trimester: Risk of fetal bradycardia, cardiac glycoside toxicity; avoids if possible. |
| Fetal Monitoring |
■ FDA Black Box Warning
Can cause potentially fatal arrhythmias; use only when clearly indicated and monitor serum levels.
| Serious Effects |
Ventricular fibrillation, digitalis toxicity, hypersensitivity, AV block (unless pacemaker present), Wolff-Parkinson-White syndrome.
| Precautions | Narrow therapeutic index; toxicity risk increased with hypokalemia, hypomagnesemia, hypercalcemia, renal impairment; monitor ECG and drug levels. |
| Food/Dietary | Avoid licorice, which can cause hypokalemia. Maintain consistent intake of potassium-rich foods (bananas, oranges) to avoid fluctuations. No known significant food interactions beyond electrolyte effects. |
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| Maternal: ECG, serum digoxin levels (therapeutic range 0.5-2 ng/mL), renal function, electrolytes (K+, Mg2+, Ca2+). Fetal: Heart rate monitoring, ultrasound for signs of hydrops or growth restriction. |
| Fertility Effects | No known significant impact on fertility in humans; animal studies show no impairment of fertility at therapeutic doses. |
| Clinical Pearls |
| Cedilanid-D (deslanoside) is a rapidly acting parenteral digitalis glycoside. Use with extreme caution in renal impairment due to reduced clearance. Monitor serum potassium and magnesium; hypokalemia and hypomagnesemia potentiate toxicity. Administer slow IV push over 5 minutes to avoid arrhythmias. Therapeutic drug monitoring less common due to short half-life of 33 hours. Contraindicated in ventricular tachycardia and AV block (unless due to atrial fibrillation). |
| Patient Advice | Take exactly as prescribed; do not double doses. · Report symptoms of toxicity: nausea, vomiting, visual disturbances (yellow-green halos), irregular heartbeat. · Avoid over-the-counter medications without consulting doctor. · Maintain consistent potassium intake; avoid high-potassium foods or supplements unless advised. · Monitor daily weight and report rapid weight gain or edema. |