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[Digoxin: continuous or discontinuous treatment?]

C A Gnocchi1, O Mazzocchi, C Yaryour

  • 1Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires.

Medicina
|August 26, 1998
PubMed
Summary

Stopping digoxin twice weekly for heart failure patients lowers drug levels below therapeutic range. Adjusting dosage based on renal function may prevent toxicity more effectively than intermittent treatment.

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Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Many countries advise patients with congestive heart failure (CHF) on chronic digoxin therapy to pause medication twice weekly to reduce digitalis toxicity.
  • Digoxin pharmacokinetics suggest a 40-50% reduction in plasma levels after two days off the drug, potentially falling below the therapeutic range (0.8-2 mg/L).

Purpose of the Study:

  • To evaluate the reduction in digoxin plasma concentration after a two-day treatment interruption.
  • To compare digoxin plasma levels between patients receiving continuous versus discontinuous (intermittent) treatment regimens.

Main Methods:

  • A prospective, randomized, single-blind trial was conducted.
  • 36 patients with CHF and systolic dysfunction (with atrial fibrillation or sinus rhythm) were enrolled.

Related Experiment Videos

  • Group 1 (19 patients) received continuous digoxin treatment; Group 2 (17 patients) took digoxin Monday-Friday.

    • Main Results:

    • In the continuous treatment group, Monday and Friday digoxin concentrations were not significantly different (1.06 ± 0.55 mg/L vs. 1.1 ± 0.57 mg/L).
    • In the discontinuous group, Monday digoxin levels (0.611 ± 0.396 mg/L) were significantly lower than Friday levels (1.04 ± 0.58 mg/L) (p=0.000002).
    • The two-day weekly suspension resulted in subtherapeutic digoxin levels.

    Conclusions:

    • Intermittent digoxin treatment (two days off per week) leads to subtherapeutic drug concentrations.
    • Continuous digoxin treatment maintains stable concentrations within the therapeutic range.
    • Adjusting digoxin dosage based on creatinine clearance, achieving average concentrations around 1 mg/L, may be a more effective strategy to prevent digitalis toxicity than treatment interruption.