Digoxin Intoxication

Öz

Digoxin is a cardiac glycoside used in the treatment of heart failure and arrhythmia. It has a positive effect on ventricular contraction. However, it causes a decrease in heart rate due to its negative effect on the atrioventricular (AV) node. The narrow therapeutic range of blood digoxin levels cause some concerns about the drug. Our aim in this article is to summarize the effects of digoxin on the cardiovascular system and current approaches in case of possible side effects.

Anahtar Kelimeler

• Digoxin
• heart failure
• pharmacokinetic profile

Kaynakça

1. Withering W. An Account of the Foxglove and Some of Its Medical Uses; with Practical Remarks on Dropsy and Other Diseases. London: GGJ and Robinson; 1785:232-52.
2. Ward RE, Gheorghiade M, Young JB, Uretsky B. Economic outcomes of withdrawal of digoxin therapy in adult patients with stable congestive heart failure. J Am Coll Cardiol. 1995;26(1):93-101.
3. Gheorghiade M, Pitt B. Digitalis Investigation Group (DIG) trial: a stimulus for further research. Am Heart J. 1997;134(1):3-12.
4. Leor J, Goldbourt U, Rabinowitz B, et al. Digoxin and increased mortality among patients recovering from acute myocardial infarction: importance of digoxin dose. The SPRINT Study Group. Cardiovasc Drugs Ther. 1995;9(5):723-9.
5. Ordog GJ, Benaron S, Bhasin V, Wasserberger J, Balasubramanium S. Serum digoxin levels and mortality in 5,100 patients. Ann Emerg Med. 1987;16(1):32-9.
6. Hickey AR, Wenger TL, Carpenter VP, et al. Digoxin Immune Fab therapy in the management of digitalis intoxication: safety and efficacy results of an observational surveillance study. J Am Coll Cardiol. 1991;17(3):590-8.
7. Taboulet P, Baud FJ, Bismuth C. Clinical features and management of digitalis poisoning--rationale for immunotherapy. J Toxicol Clin Toxicol. 1993;31(2):247-60.
8. Antman EM, Wenger TL, Butler VP Jr, Haber E, Smith TW. Treatment of 150 cases of life-threatening digitalis intoxication with digoxin-specific Fab antibody fragments. Final report of a multicenter study. Circulation. 1990;81(6):1744-52.

9. Fozzard HA, Sheets MF. Cellular mechanism of action of cardiac glycosides. J Am Coll Cardiol. 1985;5(5 Suppl A):10A-15A.
10. Eichhorn EJ, Gheorghiade M. Digoxin. Prog Cardiovasc Dis. 2002;44(4):251-66.
11. Eichhorn EJ, Bristow MR. Medical therapy can improve the biological properties of the chronically failing heart. A new era in the treatment of heart failure. Circulation. 1996;94(9):2285-96.
12. Ferguson DW, Berg WJ, Sanders JS, Roach PJ, Kempf JS, Kienzle MG. Sympathoinhibitory responses to digitalis glycosides in heart failure patients. Direct evidence from sympathetic neural recordings. Circulation. 1989;80(1):65-77.
13. Wang W, Chen JS, Zucker IH. Carotid sinus baroreceptor sensitivity in experimental heart failure. Circulation. 1990;81(6):1959-66.
14. Matsumori A, Ono K, Nishio R, et al. Modulation of cytokine production and protection against lethal endotoxemia by the cardiac glycoside ouabain. Circulation. 1997;96(5):1501-6.
15. Tsutamoto T, Wada A, Maeda K, et al. Digitalis increases brain natriuretic peptide in patients with severe congestive heart failure. Am Heart J. 1997;134(5 Pt 1):910-6.
16. Smith TW, Antman EM, Friedman PL, Blatt CM, Marsh JD. Digitalis glycosides: mechanisms and manifestations of toxicity. Part III. Prog Cardiovasc Dis. 1984;27(1):21-56.
17. Francke DE. Bioavailability of digoxin. Ann Pharmacother. 2006;40(6):1185.
18. Hauptman PJ, Kelly RA. Digitalis. Circulation. 1999;99(9):1265-70.
19. Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure: the Digitalis İnvestigation Group. N Eng J Med. 1997;336:525-33.
20. Morris SA, Hatcher HF, Reddy DK. Digoxin therapy for heart failure: an update. Am Fam Physician. 2006;74(4):613-8.
21. Cohn JN, Tristani FE, Khatri IM. Cardiac and peripheral vascular effects of digitalis in clinical cardiogenic shock. Am Heart J. 1969;78(3):318-30.
22. Hafner JV, Belknap SM, Squillante MD,Bucheit KA. Adverse drug events in emergency department patients. Ann Emerg Med. 2002;39(3):258-67.
23. Juntti-Patinen L, Kuitunen T, Pere P, Neuvonen PJ. Drug-related visits to a district hospital emergency room. Basic Clin Pharmacol Toxicol. 2006;98(2):212-7.
24. Smith TW, Antman EM, Friedman PL, Blatt CM, Marsh JD. Digitalis glycosides: mechanisms and manifestations of toxicity. Part II. Prog Cardiovasc Dis. 1984;26(6):495-540.
25. Oishi A, Miyamoto K, Kashii S, Yoshimura N. Photopsia as a manifestation of digitalis toxicity. Can J Ophthalmol. 2006 ;41(5):603-4.
26. Connors JE, DiPiro JT, Sisley JF. Use of serum drug concentrations in surgical patients. Am J Surg. 1988;156(1):68-76.
27. Rogers JJ, Heard K. Does age matter? Comparing case fatality rates for selected poisonings reported to U.S. poison centers. Clin Toxicol (Phila). 2007;45(6):705-8.
28. Antman EM, Wenger TL, Butler VP Jr, Haber E, Smith TW. Treatment of 150 cases of life-threatening digitalis intoxication with digoxin-specific Fab antibody fragments. Final report of a multicenter study. Circulation. 1990;81(6):1744-52.
29. Gheorghiade M, van Veldhuisen DJ, Colucci WS. Contemporary use of digoxin in the management of cardiovascular disorders. Circulation. 2006;113(21):2556-64.
30. Pedersen KE, Madsen J, Kjaer K, Klitgaard NA, Hvidt S. Effects of physical activity and immobilization on plasma digoxin concentration and renal digoxin clearance. Clin Pharmacol Ther. 1983;34(3):303-8.
31. Jogestrand T, Berglund B. Estimation of digital circulation and its correlation to clinical signs of ischaemia--a comparative methodological study. Clin Physiol. 1983;3(4):307-12.
32. El-Salawy SM, Lowenthal DT, Ippagunta S, Bhinder F. Clinical Pharmacology and Physiology Conference: digoxin toxicity in the elderly. Int Urol Nephrol. 2005;37(3):665-8.