The elderly are at an increased risk of digoxin toxicity. Low dosages of digoxin appear to be effective in the treatment of heart failure due to systolic dysfunction and may reduce the incidence of digitalis toxicity in these patients.
Introduction. Digoxin toxicity is a life-threatening condition. The most common symptoms are gastrointestinal and include nausea , vomiting , abdominal pain and diarrhea . The cardiac manifestations are the most concerning and can be fatal.
Digoxin is eliminated by the kidneys and toxicity typically occurs in patients who develop declining renal function due to age or other factors. Older patients have decreased renal reserve and often take medications such as ACE inhibitors, NSAIDs, or diuretics, which may adversely alter renal function.
Common side effects include feeling confused, dizzy, feeling or being sick, loss of appetite, diarrhoea , changes in your vision or skin rashes . Digoxin is usually recommended with other heart medicines when these medicines have not been enough to control your symptoms on their own.
Digoxin has long been used for the management of various conditions, including atrial fibrillation, but we would argue that it should join the ranks of drugs such as reserpine, guanethidine, and bretylium, which are no longer used because of a relative lack of efficacy and concerns about safety.
While the cause of the apparently elevated risk of dying with digoxin is not certain, it is likely that it is due to a higher risk of sudden death from cardiac arrhythmias. Most experts are now at least somewhat reluctant to recommend using digoxin for controlling the heart rate in people with atrial fibrillation.
Regardless of anticoagulant treatment, this study showed that, although all patients with AF are at risk of stroke, those taking digoxin are at a statistically significant higher risk than those who are not (hazard ratio 1.44; CI 95%, 1.22–1.69).
If you have atrial fibrillation , the following symptoms may mean that you are not getting enough digoxin: Rapid pulse (more than 100 beats per minute). Palpitations, or a feeling that your heart is racing. Change in your heart rate.
Nausea , vomiting , headache , dizziness , loss of appetite, and diarrhea may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
Given that there are other treatments for atrial fibrillation, Turakhia wonders why digoxin should be the treatment of choice for these patients . ” There are other safer drugs out there ,” he said. Safer alternatives may include drugs known as beta-blockers or calcium channel blockers, Turakhia said.
CG Statins are perhaps the most common class of drugs that can cause hepatic toxicity in patients with cardiac disease . Digoxin , which is metabolized in the liver and regulates cholesterol levels, has a bidirectional impact; it is metabolized by the liver and can affect the metabolism of other compounds in the liver .
The primary treatment of digoxin toxicity is digoxin immune fab, which is an antibody made up of anti-digoxin immunoglobulin fragments. This antidote has been shown to be highly effective in treating life-threatening signs of digoxin toxicity such as hyperkalemia, hemodynamic instability, and arrhythmias.
For people with ventricular fibrillation: Digoxin can’t be used if you have ventricular fibrillation. It may make your ventricular fibrillation worse. For people with Wolff-Parkinson-White syndrome: If you have Wolff-Parkinson-White syndrome, you’re at a higher risk for an abnormal heart rhythm.
People taking digoxin should therefore avoid taking potassium supplements, or eating large quantities of fruit (e.g., bananas), unless directed to do so by their doctor. On the other hand, many people taking digoxin are also taking a diuretic ; in these individuals, increased intake of potassium may be needed.
A decrease in sympa- thetic nervous system activity due to heart glycosides is ben- eficial in chronic heart failure. The pharmacokinetics of the two drugs differs, however; digoxin has lower oral bioavail- ability and plasma protein binding, a shorter half-life, and hence a shorter time of action than digitoxin .