What Do I Need to Know About Digoxin?

In this video I discuss the medication Digoxin as well as the benefits and risks that every patient with atrial fibrillation should know about this medication.

What do I Need to Know about Digoxin?

After isolation from the digitalis plant, the medication digoxin was first used in the 1930’s to treat a variety of heart conditions in both pill and intravenous form. Digoxin remains one of the most frequently prescribed drugs in the management of atrial fibrillation.

The main indications for digoxin in atrial fibrillation are a restoration of sinus rhythm, prevention of recurrence and slowing of the ventricular rate. However, some recent studies may suggest that patients with AFib who are taking digoxin may have an increased risk of death, whether or not they have heart failure, compared to other patients not taking the drug.

So what is the truth? Is digoxin beneficial and safe for patients with AFib? Let me break it down for you. . .

What is Digoxin?

Digoxin is an older known medication that’s been in use for years. It’s most commonly used for arrhythmia conditions such as atrial fibrillation, and atrial flutter, but can also be used to treat congestive heart failure. When it comes to atrial fibrillation specifically, it is mainly used to slow the heart rate using its electrical properties, although it cannot prevent atrial fibrillation episodes.

In this core series of videos I discuss what is atrial fibrillation and the core concepts that every patient should know about AFIb.

What Are The Benefits of Taking Digoxin?

Digoxin is a commonly used medication, with frequent application in hospital settings as it does not affect blood pressure, actually raising it to stable levels when too low. In many cases where a patient is hospitalized for atrial fibrillation, their heart rate can be 130-140 bpm. Many medications that can be used in treatment have the potential to make that blood pressure even worse, making digoxin a favorable option. Digoxin is also used in the outpatient treatment and long-term atrial fibrillation management.

What Are The Side Effects of Digoxin?

Before taking digoxin it is important to understand the potential side effects and symptoms. One of the most important aspects of digoxin that patients should be aware of is its clearance through the kidneys. If the patient interested in taking digoxin has impaired or abnormal kidney functions, common in elderly patients, then uncleared quantities of the drug can build up to potentially toxic levels.

At low levels of toxicity, digoxin can cause mild symptoms such as nausea, confusion, and visual impairments. At elevated levels, the most severe symptoms can include bradycardia, ventricular arrhythmia, ventricular tachycardia. Blood tests have shown that at the higher the levels of digoxin, there are more adverse reactions and serious outcomes. For example, multiple recent studies have shown that AFib patients taking digoxin have an increased risk of mortality. One study concluded that the possibility of mortality increased by 50% if the patient’s blood concentration exceeds a 1.2. While this is at the high end of the spectrum it is important to be aware of.

What Does Digoxin Mean for Me?

Digoxin can be an extremely beneficial medication if used in the right settings. However, given the range of the potential symptoms, its use must be carefully monitored. If you’re on digoxin, take as low a dose as possible, and make sure to routinely check your blood levels. When it comes to treating patients with digoxin, it can be useful in a short-term setting, but typically if a patient doesn’t need it, are stable on other medications, or have gotten a procedure, it is one of the last medications I recommend given the abnormal data of side effects and increased mortality.

Ultimately, if you are on digoxin, talk to your doctor about your dosage, and monitor the levels of digoxin in your blood. (The higher the blood level, the higher the potential for health risks.)

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For more information on all things Atrial Fibrillation, explore previous blog posts.