What Is Digoxin Used For? Comprehensive Guide

Digoxin is primarily used to manage heart failure and control heart rate in atrial fibrillation, especially when first-line treatments are ineffective; learn more at WHAT.EDU.VN. This medication, derived from Digitalis lanata, enhances heart muscle contraction and slows down the heart rate, improving cardiac output and overall heart function. Explore further to understand its uses, side effects, and how it’s managed for optimal health outcomes with detailed insights into digoxin therapy.

1. What Is Digoxin?

Digoxin, derived from the foxglove plant Digitalis lanata, is a cardiac glycoside used to treat heart conditions such as atrial flutter, atrial fibrillation, and heart failure. Approved by the FDA in 1954, digoxin enhances myocardial contraction and controls ventricular response rates. Though once widely used, it’s now reserved for cases where first-line agents are ineffective, owing to the emergence of safer alternatives.

Caption: The chemical structure of Digoxin.

1.1 What Are the FDA-Approved Indications for Digoxin?

Digoxin is FDA-approved for treating chronic atrial fibrillation and managing symptoms of heart failure. It’s beneficial for heart failure patients with reduced ejection fraction (≤40%), though it does not reduce mortality. Digoxin is also used for rate control in atrial fibrillation or flutter when conventional therapies fail, but it should be avoided in cases of preexcitation due to accessory pathways, as it may trigger ventricular tachyarrhythmias.

1.2 What Are the Off-Label Uses of Digoxin?

Digoxin was previously used off-label to induce fetal death before second-trimester abortions, but this use has decreased due to safety concerns. It has also been used to treat fetal supraventricular tachyarrhythmia and as a rate-control agent in supraventricular tachycardia, especially AV nodal reentrant tachycardia. In cases where traditional therapies fail, digoxin may be beneficial for managing symptomatic supraventricular tachycardia.

2. How Does Digoxin Work?

Digoxin works through two primary mechanisms: AV node inhibition and enhancement of myocardial contraction. It stimulates the parasympathetic nervous system, slowing electrical conduction through the AV node and reducing heart rate. It also increases intracellular calcium levels, prolonging the AV node’s refractory period and decreasing ventricular response.

2.1 What Is the Role of Digoxin in AV Node Inhibition?

Digoxin exerts vagomimetic effects on the AV node, stimulating the parasympathetic nervous system to slow electrical conduction and reduce heart rate. This action prolongs phases 4 and 0 of the cardiac action potential, extending the AV node’s refractory period and decreasing ventricular response.

2.2 How Does Digoxin Enhance Myocardial Contraction?

Digoxin inhibits the sodium-potassium ATPase pump in myocardial cells, leading to an increase in intracellular sodium. This, in turn, reduces the activity of the sodium-calcium exchanger, causing an accumulation of intracellular calcium. The increased calcium enhances the force of myocardial contraction, improving cardiac output.

3. How Is Digoxin Administered?

Digoxin is available in oral and injectable forms, with intravenous (IV) administration preferred for rapid digitalization. Key considerations for administration include obtaining an ECG before use, assessing and normalizing electrolyte levels, and monitoring plasma digoxin levels to confirm steady-state levels.

Caption: Digoxin tablets of various strengths.

3.1 What Are the Available Dosage Forms and Strengths of Digoxin?

Digoxin is available in the following formulations:

Oral solution: 0.05 mg/mL
Injectable solution: 0.1 mg/mL and 0.25 mg/mL
Tablets: 0.0625 mg, 0.125 mg, 0.1875 mg, and 0.25 mg

3.2 What Is the Recommended Adult Dosage for Heart Failure?

For heart failure, the recommended digoxin dosage is 0.125 to 0.25 mg/day, tailored to the individual patient and guided by a dosing nomogram to achieve a target serum digoxin concentration of 0.5 to less than 0.9 ng/mL, according to ACC/AHA guidelines.

3.3 How Is Digoxin Dosed for Atrial Fibrillation?

For atrial fibrillation, the initial loading dose of digoxin is 0.25 to 0.5 mg, administered over several minutes, with additional doses of 0.25 mg every 6 hours, not exceeding 1.5 mg in 24 hours. The maintenance dosage typically ranges from 0.0625 to 0.25 mg/day, and plasma concentrations exceeding 1.2 ng/mL are linked to an increased mortality risk, as per the 2023 ACC/AHA/ACCP/HRS guidelines.

4. What Are the Adverse Effects of Digoxin?

Digoxin toxicity can lead to fatal cardiac arrhythmias, with the risk increasing when serum digoxin concentrations exceed 2.0 ng/mL. Common symptoms include nausea, vomiting, anorexia, and visual disturbances such as color changes (xanthopsia). At toxic levels, digoxin can be proarrhythmic, with an impaired ventricle being more susceptible to ventricular tachyarrhythmias and ectopy.

4.1 What Are the Common Drug-Drug Interactions with Digoxin?

Drug interactions with digoxin include:

Azole antifungals: May increase digoxin levels by inhibiting P-glycoprotein.
Macrolide antibiotics: Can increase intestinal absorption of digoxin by inhibiting P-glycoprotein.
Class III antiarrhythmic drugs: Concomitant use of dofetilide with digoxin increases the risk of torsades de pointes.
Ibarbadine: Increases the risk of bradycardia when used concurrently with digoxin.
Quinidine: May significantly increase serum digoxin levels, requiring a dose reduction of digoxin.
IV calcium products: Rapid IV administration can induce severe arrhythmias in digitalized patients.

4.2 What Are the Contraindications for Digoxin Use?

Digoxin is contraindicated in the following conditions:

Acute myocardial infarction
Ventricular fibrillation
Hypersensitivity to the drug

5. How Is Digoxin Monitored?

Digoxin has a narrow therapeutic index, with recommended serum levels ranging from 0.8 to 2 ng/mL. Blood should be drawn at least 6 to 8 hours after the last dose to accurately measure serum digoxin levels. Regular ECGs and bloodwork are essential to assess renal function and electrolyte levels.

5.1 What Are the Recommended Serum Digoxin Levels?

For heart failure, the 2013 ACC Foundation guidelines and AHA recommend digoxin plasma levels between 0.5 and 0.9 ng/mL. The 2022 guidelines from the AHA, ACC, and Heart Failure Society of America suggest an upper limit of 1.0 ng/mL, noting increased mortality risks at 1.2 ng/mL or higher.

5.2 What ECG Changes Are Associated with Digoxin?

ECG changes associated with digoxin include downsloping ST-segment depression, often referred to as the “reverse check” sign, and a decreased QT interval. Regular digoxin use can also result in a prolonged PR interval and T wave inversion or flattening.

6. How Is Digoxin Toxicity Managed?

Digoxin toxicity presents with symptoms such as nausea, vomiting, anorexia, fatigue, and life-threatening arrhythmias. Management includes discontinuing digoxin, correcting electrolyte imbalances, and administering digoxin immune fab in severe cases.

6.1 What Are the Signs and Symptoms of Digoxin Overdose?

Common signs of digoxin toxicity include:

Nausea
Vomiting
Anorexia
Fatigue
Bradycardia
Confusion
Weakness
Visual disturbances (xanthopsia, diplopia, photophobia)

6.2 When Is Digoxin Immune Fab Indicated?

Digoxin immune fab is indicated in the following conditions:

Any life-threatening digoxin-related dysrhythmia
Refractory hyperkalemia
Serum digoxin concentration greater than 15 ng/mL at any time or above 10 ng/mL 6 hours post-ingestion
Acute ingestion of 10 mg in adults
Acute ingestion of 4 mg in children
Chronic elevation of serum digoxin concentration with altered mental status, dysrhythmias, or severe gastrointestinal symptoms

7. How Does Digoxin Affect Specific Patient Populations?

Dosage adjustments for digoxin are crucial in specific patient populations, including those with renal impairment, pregnancy, and older adults. Monitoring and individualized treatment approaches are essential to optimize clinical outcomes.

7.1 How Should Digoxin Dosage Be Adjusted for Renal Impairment?

Patients with impaired renal function require reduced maintenance doses of digoxin due to its close relationship with creatinine clearance. The extended elimination half-life in these individuals increases the risk of toxicity if dosing adjustments are not made appropriately.

7.2 What Are the Pregnancy Considerations for Digoxin Use?

Digoxin crosses the placenta, making it important to monitor neonates for signs of toxicity following in-utero exposure. Pregnancy increases susceptibility to arrhythmias and can exacerbate preexisting cardiac conditions, necessitating dosage adjustments. Digoxin is recommended as a first-line treatment for symptomatic supraventricular tachycardia during pregnancy.

7.3 How Does Age Affect Digoxin Dosage?

For patients aged 70 or older, those with impaired renal function, or individuals with low lean body mass, a low starting dosage of digoxin (0.125 mg/day or every other day) should be considered for initial treatment, according to ACC/AHA guidelines.

8. What Is the Role of the Healthcare Team in Digoxin Therapy?

An interprofessional healthcare team, including clinicians, specialists, advanced-practice providers, nurses, and pharmacists, is essential for overseeing digoxin therapy to optimize therapy and prevent adverse effects. Collaboration, information sharing, and coordinated care are crucial for managing digoxin toxicity and improving patient outcomes.

Caption: A diverse healthcare team collaborating to improve patient care.

8.1 How Can Clinicians and Specialists Optimize Digoxin Therapy?

Clinicians and specialists can optimize digoxin therapy by carefully monitoring serum digoxin levels, assessing renal function and electrolyte levels, and adjusting dosages based on individual patient characteristics and comorbidities. Consultation with a nephrologist should be considered if emergent hemodialysis is indicated.

8.2 What Is the Pharmacist’s Role in Preventing Adverse Effects of Digoxin?

Pharmacists play a crucial role in preventing adverse effects of digoxin by reviewing the patient’s medication profile for potential drug interactions and ensuring appropriate dosing adjustments. They can also provide education to patients and healthcare providers on the safe use of digoxin.

8.3 How Do Nurses Contribute to Monitoring and Managing Digoxin Toxicity?

Nurses contribute to monitoring and managing digoxin toxicity by assessing patients for signs and symptoms of toxicity, monitoring ECGs and electrolyte levels, and promptly reporting any concerns to the healthcare team. They also play a key role in providing supportive care, including IV hydration and electrolyte repletion.

9. Emerging Research and Future Directions for Digoxin Use

Recent studies have focused on optimizing digoxin therapy in specific patient populations and exploring potential new applications for this medication. Further research is needed to clarify the role of digoxin in heart failure and atrial fibrillation management.

9.1 What Does Current Research Say About Digoxin and Mortality Risks?

Current research indicates a correlation between elevated serum digoxin concentrations and increased mortality and morbidity in patients with atrial fibrillation and heart failure with reduced ejection fraction. These findings underscore the importance of careful monitoring and personalized treatment strategies to improve patient outcomes.

9.2 Are There Any Novel Uses Being Explored for Digoxin?

While digoxin’s primary uses remain in heart failure and atrial fibrillation management, ongoing research explores potential novel applications in cancer therapy and other areas. However, these uses are still under investigation and not yet established in clinical practice.

10. Frequently Asked Questions About Digoxin

Below are some frequently asked questions (FAQs) about digoxin, covering its uses, side effects, and management.

Question	Answer
What is digoxin primarily used for?	Digoxin is primarily used to manage heart failure and control heart rate in atrial fibrillation, especially when first-line treatments are ineffective.
What are the common side effects of digoxin?	Common side effects include nausea, vomiting, anorexia, visual disturbances (such as xanthopsia), bradycardia, and fatigue.
How is digoxin toxicity managed?	Management includes discontinuing digoxin, correcting electrolyte imbalances, administering activated charcoal in acute overdose, and using digoxin immune fab in severe cases.
What are the contraindications for digoxin use?	Contraindications include acute myocardial infarction, ventricular fibrillation, and hypersensitivity to the drug.
How often should digoxin levels be monitored?	Digoxin levels should be checked 1 week after starting the medication and regularly afterward, with blood drawn at least 6 to 8 hours after the last dose.
Can digoxin be used during pregnancy?	Digoxin can be used during pregnancy for specific indications, such as supraventricular tachycardia, but it requires careful monitoring due to its ability to cross the placenta.
What drug interactions should be considered with digoxin?	Significant drug interactions include azole antifungals, macrolide antibiotics, class III antiarrhythmic drugs, quinidine, and IV calcium products.
How does renal impairment affect digoxin dosage?	Patients with renal impairment require reduced maintenance doses of digoxin due to its reliance on renal clearance; dosage adjustments are crucial to prevent toxicity.
What ECG changes are associated with digoxin use?	ECG changes include downsloping ST-segment depression (“reverse check” sign), decreased QT interval, prolonged PR interval, and T wave inversion or flattening.
What role does the healthcare team play in digoxin therapy management?	An interprofessional team including clinicians, specialists, nurses, and pharmacists collaborates to optimize therapy, prevent adverse effects, monitor drug levels, and provide patient education for safe and effective digoxin use. Collaboration ensures comprehensive care and improved patient outcomes.

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References:

Singhai H, Rathee S, Jain SK, Patil UK. The Potential of Natural Products in the Management of Cardiovascular Disease. Curr Pharm Des. 2024;30(8):624-638. PubMed: 38477208
Grubb A, Mentz RJ. Pharmacological management of atrial fibrillation in patients with heart failure with reduced ejection fraction: review of current knowledge and future directions. Expert Rev Cardiovasc Ther. 2020 Feb;18(2):85-101. PubMed: 32066285
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW., ACC/AHA Joint Committee Members. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 May 03;145(18):e895-e1032. PubMed: 35363499
Writing Committee Members. Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2024 Jan 02;83(1):109-279. PMC free article: PMC11104284 PubMed: 38043043
Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NA, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM., Evidence Review Committee Chair‡ 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2016 Apr 05;133(14):e506-74. PubMed: 26399663
Alsaied T, Baskar S, Fares M, Alahdab F, Czosek RJ, Murad MH, Prokop LJ, Divanovic AA. First-Line Antiarrhythmic Transplacental Treatment for Fetal Tachyarrhythmia: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2017 Dec 15;6(12) PMC free article: PMC5779032 PubMed: 29246961
Ren Y, Ribas HT, Heath K, Wu S, Ren J, Shriwas P, Chen X, Johnson ME, Cheng X, Burdette JE, Kinghorn AD. Na+/K+-ATPase-Targeted Cytotoxicity of (+)-Digoxin and Several Semisynthetic Derivatives. J Nat Prod. 2020 Mar 27;83(3):638-648. PMC free article: PMC7243443 PubMed: 32096998
Khandelwal R, Vagha JD, Meshram RJ, Patel A. A Comprehensive Review on Unveiling the Journey of Digoxin: Past, Present, and Future Perspectives. Cureus. 2024 Mar;16(3):e56755. PMC free article: PMC11033962 PubMed: 38650769
Lunney M, Ruospo M, Natale P, Quinn RR, Ronksley PE, Konstantinidis I, Palmer SC, Tonelli M, Strippoli GF, Ravani P. Pharmacological interventions for heart failure in people with chronic kidney disease. Cochrane Database Syst Rev. 2020 Feb 27;2(2):CD012466. PMC free article: PMC7044419 PubMed: 32103487
Hindi J, Fréchette-Le Bel M, Rouleau JL, de Denus S. Influence of Weight and Body Size on the Pharmacokinetics of Heart Failure Pharmacotherapy: A Systematic Review. Ann Pharmacother. 2024 Mar;58(3):255-272. PubMed: 37338205
Djohan AH, Sia CH, Singh D, Lin W, Kong WK, Poh KK. A myriad of electrocardiographic findings associated with digoxin use. Singapore Med J. 2020 Jan;61(1):9-14. PMC free article: PMC7900815 PubMed: 32043160
Writing Committee Members; ACC/AHA Joint Committee Members. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Card Fail. 2022 May;28(5):e1-e167. PubMed: 35378257
Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR., Peer Review Committee Members. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024 Jan 02;149(1):e1-e156. PMC free article: PMC11095842 PubMed: 38033089
Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, Iung B, Johnson MR, Kintscher U, Kranke P, Lang IM, Morais J, Pieper PG, Presbitero P, Price S, Rosano GMC, Seeland U, Simoncini T, Swan L, Warnes CA., ESC Scientific Document Group. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018 Sep 07;39(34):3165-3241. PubMed: 30165544
Drugs and Lactation Database (LactMed®) [Internet]. National Institute of Child Health and Human Development; Bethesda (MD): Sep 15, 2024. Digoxin. PubMed: 30000905
Bromley HL, Dave R, Lord N, Wright P, Rowland M, Gandhi A. Gynaecomastia: when and why to refer to specialist care. Br J Gen Pract. 2021 Apr;71(705):185-188. PMC free article: PMC8007267 PubMed: 33771805
Yanagisawa Y, Ibrahim W, Kumar N. A case of atrial fibrillation complicated by complete atrioventricular block. SAGE Open Med Case Rep. 2023;11:2050313X231157486. PMC free article: PMC9972045 PubMed: 36866023
Fu JL, Yu Q, Li MD, Hu CM, Shi G. Deleterious cardiovascular effect of exosome in digitalis-treated decompensated congestive heart failure. J Biochem Mol Toxicol. 2020 May;34(5):e22462. PubMed: 32045083
Mutlu M, Aslan Y, Kader Ş, Aktürk-Acar F, Dilber E. Clinical signs and symptoms of toxic serum digoxin levels in neonates. Turk J Pediatr. 2019;61(2):244-249. PubMed: 31951334
Angraal S, Nuti SV, Masoudi FA, Freeman JV, Murugiah K, Shah ND, Desai NR, Ranasinghe I, Wang Y, Krumholz HM. Digoxin Use and Associated Adverse Events Among Older Adults. Am J Med. 2019 Oct;132(10):1191-1198. PubMed: 31077654
Gona SR, Rosenberg J, Fyffe-Freil RC, Kozakiewicz JM, Money ME. Review: Failure of current digoxin monitoring for toxicity: new monitoring recommendations to maintain therapeutic levels for efficacy. Front Cardiovasc Med. 2023;10:1179892. PMC free article: PMC10350506 PubMed: 37465455
Negroni MS, Marengo A, Caruso D, Tayar A, Rubiolo P, Giavarini F, Persampieri S, Sangiovanni E, Davanzo F, Carugo S, Colombo ML, Dell’Agli M. A Case Report of Accidental Intoxication following Ingestion of Foxglove Confused with Borage: High Digoxinemia without Major Complications. Case Rep Cardiol. 2019;2019:9707428. PMC free article: PMC6906804 PubMed: 31871798
Javid S, Gohil NV, Ali S, Tangella AV, Hingora MJH, Hussam MA, Fatima M, Alam AF, Al-Khazraji Y, Saddique MN, Ashraf A, Mumtaz H, Liaquat A. Association of serum digoxin concentration with morbidity and mortality in patients with atrial fibrillation, heart failure and reduced ejection fraction of 45 % or below. Curr Probl Cardiol. 2024 Feb;49(2):102218. PubMed: 38000566
Haruna Y, Kawasaki T, Kikkawa Y, Mizuno R, Matoba S. Xanthopsia Due to Digoxin Toxicity as a Cause of Traffic Accidents: A Case Report. Am J Case Rep. 2020 Aug 08;21:e924025. PMC free article: PMC7440749 PubMed: 32769961
Alanís-Naranjo JM, Aragón-Ontiveros KD, Rivera-Hermosillo JC, Campos-Garcilazo V. Bidirectional ventricular tachycardia due to digoxin-diuretic interaction in post-cardiac surgery patient: a case report. Arch Peru Cardiol Cir Cardiovasc. 2024 Apr-Jun;5(2):e362. PMC free article: PMC11247964 PubMed: 39015194
Almarzuqi A, Kimber S, Quadros K, Senaratne J. Bidirectional Ventricular Tachycardia: Challenges and Solutions. Vasc Health Risk Manag. 2022;18:397-406. PMC free article: PMC9188370 PubMed: 35698640
Hack JB, Wingate S, Zolty R, Rich MW, Hauptman PJ. Expert Consensus on the Diagnosis and Management of Digoxin Toxicity. Am J Med. 2025 Jan;138(1):25-33.e14. PubMed: 39265879
Writing Committee Members. Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Heart Rhythm. 2019 Sep;16(9):e227-e279. PubMed: 30412777