Supervised withdrawal of long-term digoxin therapy

All 32 patients treated with digoxin for over three months in one practice population had treatment withdrawn under supervision to assess its continued requirement. In 18 instances (56%) digoxin proved necessary and was restarted to correct clinical deterioration, while in 14 instances (44%) it was successfully discontinued. Successful withdrawal was more frequently achieved in those with sinus rhythm (91% of 14 patients) than in atrial fibrillation (19% of 21 patients). Where digoxin was required dosage increases were necessary to achieve optimum clinical control. Adherence to a strict protocol allows unnecessary therapy to be withdrawn and facilitates improved care when therapy is required, with accompanying savings in costs and time.