Effects of Digoxin in Heart Failure (HF) With Reduced Ejection Fraction (EF)

Parikh, Riya R; Patel, Khushbu R; Pergolizzi, Joseph V.; Breve, Frank; Magnusson, Peter

doi:10.7759/cureus.22778

Cited by 4 publications

(2 citation statements)

References 25 publications

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“…Although digoxin is no longer considered a first line treatment for congestive heart failure ( 39 ), it is still being used for rate control in atrial fibrillation when hypotension develops due to attempts to increase the dose of other cardiac medications ( 40 ). With the aging population, atrial fibrillation is becoming a “global epidemic” ( 41 ).…”

Section: Introductionmentioning

confidence: 99%

Review: Failure of current digoxin monitoring for toxicity: new monitoring recommendations to maintain therapeutic levels for efficacy

Gona,

Rosenberg,

Fyffe-Freil

et al. 2023

Front. Cardiovasc. Med.

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The current recommendations for monitoring digoxin, a narrow therapeutic index drug, are limited to confirming medication use or investigating suspicion of toxicity and fail our oath to do no harm. Numerous meta-analyses evaluating digoxin use consistently recommend frequent monitoring to maintain the level of 0.5 to ≤1.0 ng/ml because higher levels lead to increased morbidity and mortality without benefit. Data from the United States National Poison Control Center (2012–2020) show annual deaths due to digoxin of 18–36 compared to lithium's 1–7, and warfarin's 0–2 respectively. The latter drugs also have narrow therapeutic indexes like digoxin yet are more carefully monitored. Recognition of digoxin toxicity is impaired as levels are not being routinely checked after medications are added to a patient's regimen. In addition, providers may be using ranges to guide treatment that are no longer appropriate. It is imperative that monitoring guidelines and laboratory therapeutic levels are revised to reduce morbidity and mortality due to digoxin. In this review, we provide a comprehensive literature review of digoxin monitoring guidelines, digoxin toxicity, and evidence to support revising the ranges for serum digoxin monitoring.

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Section: Introductionmentioning

confidence: 99%

Review: Failure of current digoxin monitoring for toxicity: new monitoring recommendations to maintain therapeutic levels for efficacy

Gona,

Rosenberg,

Fyffe-Freil

et al. 2023

Front. Cardiovasc. Med.

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“…This is especially true for cardiac glycosides, which can be applied in clinical practice only cautiously due to their very narrow therapeutic window. The use of digoxin is well-explained in heart failure (HF) patients with reduced ejection fraction; however, the supporting evidence is conflicting [ 4 ]. A recent systematic review and meta-analysis reported that digoxin has no effect on the all-cause mortality and hospitalization in heart failure with preserved ejection fraction patients [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Antiarrhythmic and Inotropic Effects of Selective Na+/Ca2+ Exchanger Inhibition: What Can We Learn from the Pharmacological Studies?

Nagy

Tóth²,

Nánási

2022

IJMS

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Life-long stable heart function requires a critical balance of intracellular Ca2+. Several ion channels and pumps cooperate in a complex machinery that controls the influx, release, and efflux of Ca2+. Probably one of the most interesting and most complex players of this crosstalk is the Na+/Ca2+ exchanger, which represents the main Ca2+ efflux mechanism; however, under some circumstances, it can also bring Ca2+ into the cell. Therefore, the inhibition of the Na+/Ca2+ exchanger has emerged as one of the most promising possible pharmacological targets to increase Ca2+ levels, to decrease arrhythmogenic depolarizations, and to reduce excessive Ca2+ influx. In line with this, as a response to increasing demand, several more or less selective Na+/Ca2+ exchanger inhibitor compounds have been developed. In the past 20 years, several results have been published regarding the effect of Na+/Ca2+ exchanger inhibition under various circumstances, e.g., species, inhibitor compounds, and experimental conditions; however, the results are often controversial. Does selective Na+/Ca2+ exchanger inhibition have any future in clinical pharmacological practice? In this review, the experimental results of Na+/Ca2+ exchanger inhibition are summarized focusing on the data obtained by novel highly selective inhibitors.

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Association of serum digoxin concentration with morbidity and mortality in patients with atrial fibrillation, heart failure and reduced ejection fraction of 45 % or below

Javid,

Gohil,

Ali

et al. 2024

Current Problems in Cardiology

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Effects of Digoxin in Heart Failure (HF) With Reduced Ejection Fraction (EF)

Cited by 4 publications

References 25 publications

Review: Failure of current digoxin monitoring for toxicity: new monitoring recommendations to maintain therapeutic levels for efficacy

Review: Failure of current digoxin monitoring for toxicity: new monitoring recommendations to maintain therapeutic levels for efficacy

Antiarrhythmic and Inotropic Effects of Selective Na+/Ca2+ Exchanger Inhibition: What Can We Learn from the Pharmacological Studies?

Association of serum digoxin concentration with morbidity and mortality in patients with atrial fibrillation, heart failure and reduced ejection fraction of 45 % or below

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