Digoxin is still useful, but is still causing toxicity
Alejandro Durán Crane1, Michael Militello2, Michael D Faulx3
1Cardiovascular Medicine Fellow, Cleveland Clinic, Cleveland, OH.
Abstract:
Digoxin, the oldest known cardiovascular drug, is still used today to treat heart failure and atrial fibrillation. Because it has a narrow therapeutic index and multiple interactions, it frequently causes toxicity with a wide range of symptoms and cardiac arrhythmias. More importantly, elevated serum digoxin levels have been linked to a higher risk of death in patients with heart failure or atrial fibrillation, even without signs or symptoms of toxicity. This article reviews the current state of digoxin use, its pharmacologic principles, and the mechanisms, clinical presentation, and management of toxicity.
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