Is digoxin a drug of the past?

Abstract

Digoxin has been the cornerstone of the treatment of heart failure for more than 2 centuries. Now that newer therapies have been introduced that reduce the mortality rate in heart failure and recent trials have failed to prove the same for digoxin, its use has significantly decreased. But a careful review of the multiple pharmacologic actions of digoxin and closer analysis of the results of recent trials suggest that digoxin may in fact continue to be an effective treatment for heart failure.

The cardiotonic steroid hormone marinobufagenin induces renal fibrosis: implication of epithelial-to-mesenchymal transition

“…CTSs such as digoxin and digitoxin are still an important component of the clinical treatment of cardiac diseases (26,65). CTSs were discovered in digitalis plants and amphibian tissues (25,75).…”

Digoxin, Diuretics, and Vasodilators in Heart Failure

“…It has been speculated that the retrospective subgroup analysis that suggested the increased risk may have been related to higher mean digoxin levels among women compared to men. A more recent analysis using a multivariate Cox proportional hazards regression model found that at lower serum concentrations (0.5-0.9 ng/mL), digoxin did not increase mortality in women [8]. Moreover, low serum digoxin concentrations in women decreased the risk of hospitalization for worsening HF and the combined endpoint of mortality due to HF and HF hospitalization.…”

“…So, it seems clear then that if digoxin is going to be used, it should be given in a dose to achieve a serum digoxin concentration between 0.5 and 0.9 ng/mL given the limited evidence currently available [8]. In particular, the serum digoxin concentration achieved in the RADIANCE Trial was 1.2 ng/mL and in the DIG Trial it was 0.8 ng/dL [7].…”

“…The recent, more-detailed analyses looking at the impact of serum digoxin concentrations suggests it is possible that digoxin use at a low serum concentration might reduce mortality. This beneficial effect is potentially due to the neurohormonal and autonomic effects that are present at lower serum digoxin concentrations than traditionally used [8].…”

“…The dose of digoxin should be reduced if treatment with these drugs is initiated. In monitoring serum digoxin concentrations a true steady-state level blood sample should be obtained greater than 8 hours after a digoxin dose and preferably 1 week after any change in dose owing to the long (>30 hour) half-life of digoxin [8].…”