Digoxin

Digoxin is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

  • Digoxin is a cardioactive steroid that was previously used in the treatment of CHF and arrhythmias (typically refractory atrial fibrillation).
  • Other cardioactive steroids with digoxin-like effects are found in many plants and animals, including foxglove, red squill, oleander, and the Bufo toad.

Pathophysiology

  • Digoxin inhibits the sodium/potassium ATPase pump, producing a rise in the intracellular sodium concentration that indirectly leads to an increase in the intracellular calcium concentration.
  • The overall effect of digoxin is thus to enhance vagal tone (therefore suppressing conduction of atrial impulses to the ventricles), increase cardiac excitability (which predisposes to arrhythmias), and enhance inotropy.
  • Unfortunately, digoxin has a very narrow therapeutic index, and accidental poisoning is relatively common, especially in patients with fluctuating renal function.

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General Principles

  • Digoxin is a cardioactive steroid that was previously used in the treatment of CHF and arrhythmias (typically refractory atrial fibrillation).
  • Other cardioactive steroids with digoxin-like effects are found in many plants and animals, including foxglove, red squill, oleander, and the Bufo toad.

Pathophysiology

  • Digoxin inhibits the sodium/potassium ATPase pump, producing a rise in the intracellular sodium concentration that indirectly leads to an increase in the intracellular calcium concentration.
  • The overall effect of digoxin is thus to enhance vagal tone (therefore suppressing conduction of atrial impulses to the ventricles), increase cardiac excitability (which predisposes to arrhythmias), and enhance inotropy.
  • Unfortunately, digoxin has a very narrow therapeutic index, and accidental poisoning is relatively common, especially in patients with fluctuating renal function.

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