Atrial fibrillation and flutter in patients hospitalized for COVID‐19: The challenging role of digoxin

Siniorakis, Eftychios; Arvanitakis, Spyridon; Katsianis, Antonios; Elkouris, Maximilianos

doi:10.1111/jce.14894

Cited by 7 publications

(4 citation statements)

References 9 publications

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“…In many cases, glycoside ingestion was due to erroneous identification of leaves, not always easily distinguishable from those of other edible plants [4,5]. Moreover, recent studies have highlighted a possible role of digoxin and digitoxin in the treatment of Covid-19 or cancer [6][7][8][9]. On these grounds, accurately monitoring the concentrations of digoxin and digitoxin in biofluids and tissues is still of utmost importance in both clinical practice and research.…”

Section: Introductionmentioning

confidence: 99%

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Development of a new ultra‐high‐performance liquid chromatography–tandem mass spectrometry method for the determination of digoxin and digitoxin in plasma: Comparison with a clinical immunoassay

et al. 2022

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Cardiac glycosides digoxin and digitoxin are used in therapy for the treatment of congestive heart failure. Moreover, these compounds can be responsible for intoxication cases caused by fortuitous ingestion of leaves of Digitalis. Due to the narrow therapeutic range of these drugs, therapeutic drug monitoring is recommended in the clinical practice. In this context, immunoassays‐based methods are generally employed but digoxin‐ and digitoxin‐like compounds can interfere with the analysis. The aim of this study was to develop and validate an original UPLC–MS/MS method for the determination of digoxin and digitoxin in plasma. The method shows adequate sensitivity and selectivity with acceptable matrix effects and very good linearity, accuracy, precision, and recovery. A simple liquid–liquid extraction procedure was used for sample clean‐up. The method was applied for the analysis of n = 220 plasma samples collected in two different clinical chemistry laboratories and previously tested by the same immunoassay. The statistical comparison showed a relevant negative bias of the UPLC–MS/MS method versus the immunoassay. These results are consistent with an immunoassay overestimation of digoxin plasmatic levels due to cross‐reaction events with endogenous digoxin‐like substances.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Development of a new ultra‐high‐performance liquid chromatography–tandem mass spectrometry method for the determination of digoxin and digitoxin in plasma: Comparison with a clinical immunoassay

et al. 2022

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“…Several studies have also reported on the antiviral and anti-inflammatory properties of cardiac glycosides via inhibition of the entrance of coronavirus into the cells and suppression of a cytokine storm. 3 However, concerns for digoxin use in patients with COVID-19 include issues such as the risk of an interaction between digoxin and the drug used for the treatment of COVID-19, inhibition of digoxin metabolism due to increased cytokine levels during COVID-19 infection, and atrial fibrillation and electrolyte imbalance due to COVID-19 itself. Therefore, in spite of the antiviral and anti-inflammatory benefits of digoxin in patients with COVID-19, the need for frequent monitoring of the digoxin level should be considered.…”

mentioning

confidence: 99%

“…2 Furthermore, atrial fibirllation and flutter were observed in 16% of hospitalised patients with COVID-19 and 60% of arrhythmias were reported as new onset. 3 However, due to the high mortality risk, atrial fibrillation and flutter should be treated, even with the risk of drug toxicity.…”

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confidence: 99%

Benefit versus toxicity risk of digoxin in patients with COVID-19

2021

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Covid-19 and development of heart failure: mystery and truth

Onohuean

Al-Kuraishy

Al-Gareeb

et al. 2021

Naunyn-Schmiedeberg's Arch Pharmacol

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Coronavirus disease 2019 (Covid-19) is a novel worldwide pandemic caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). During Covid-19 pandemic, socioeconomic deprivation, social isolation, and reduced physical activities may induce heart failure (HF), destabilization, and cause more complications. HF appears as a potential hazard due to SARS-CoV-2 infection, chiefly in elderly patients with underlying comorbidities. In reality, the expression of cardiac ACE2 is implicated as a target point for SARS-CoV-2-induced acute cardiac injury. In SARS-CoV-2 infection, like other febrile illnesses, high blood viscosity, exaggerated pro-inflammatory response, multisystem inflammatory syndrome, and endothelial dysfunction-induced coagulation disorders may increase risk of HF development. Hypoxic respiratory failure, as in pulmonary edema, severe acute lung injury (ALI), and acute respiratory distress syndrome (ARDS) may affect heart hemodynamic stability due to the development of pulmonary hypertension. Indeed, Covid-19-induced HF could be through the development of cytokine storm, characterized by high proliferation pro-inflammatory cytokines. In cytokine storm-mediated cardiac dysfunction, there is a positive correlation between levels of pro-inflammatory cytokine and myocarditis-induced acute cardiac injury biomarkers. Therefore, Covid-19-induced HF is more complex and related from a molecular background in releasing pro-inflammatory cytokines to the neuro-metabolic derangements that together affect cardiomyocyte functions and development of HF. Anti-heart failure medications, mainly digoxin and carvedilol, have potent anti-SARS-CoV-2 and anti-inflammatory properties that may mitigate Covid-19 severity and development of HF. In conclusion, SARS-CoV-2 infection may lead to the development of HF due to direct acute cardiac injury or through the development of cytokine storms, which depress cardiomyocyte function and cardiac contractility. Anti-heart failure drugs, mainly digoxin and carvedilol, may attenuate severity of HF by reducing the infectivity of SARS-CoV-2 and prevent the development of cytokine storms in severely affected Covid-19 patients.

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Atrial fibrillation and flutter in patients hospitalized for COVID‐19: The challenging role of digoxin

Cited by 7 publications

References 9 publications

Development of a new ultra‐high‐performance liquid chromatography–tandem mass spectrometry method for the determination of digoxin and digitoxin in plasma: Comparison with a clinical immunoassay

Development of a new ultra‐high‐performance liquid chromatography–tandem mass spectrometry method for the determination of digoxin and digitoxin in plasma: Comparison with a clinical immunoassay

Benefit versus toxicity risk of digoxin in patients with COVID-19

Covid-19 and development of heart failure: mystery and truth

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