Mechanism of Action
- Improves myocardial contraction by altering the calcium utilization of the myocardial cell.
- Slows cardiac conduction through the AV node (ACC)
- Congestive Heart Failure (CHF)
- Associated fluid retention (edema)
- Atrial fibrillation
- Atrial flutter
- Digoxin (Lanoxin)
- Digitoxin (Crystodigin)
- Digitalis (Digitortis)
Effects during Exercise and Rest
- Heart Rate
- Decrease heart rate in patients with atrial fibrillation and possibly CHF (ACSM 2013)
- No significant change in heart rate in patients with sinus rhythm (ACSM 2013)
- Improve exercise capacity only in patients atrial fibrillation or CH (ACSM 2013)
- No change in blood pressure during rest or exercise (ACSM 2013)
- Nonspecific ST-T wave changes during rest (ACSM 2013)
- ST-segment depression during exercise (ACSM 2013)
Potential Side Effects
- Arrhythmias at higher dose levels
- Toxicity due to a narrow therapeutic index
- Toxicity is cumulative
- Symptomatic chronic heart failure for patients with reduced systolic function, preservation of systolic function, and/or rate control for atrial fibrillation with a rapid ventricular response (ACC)
Populations Not Recommended
- Pregnant or nursing mothers
- Patients with acute MI, myocarditis, or ventricular fibrillation (ACC)
American College of Sports Medicine (2013). Guidelines for Exercise Testing and Prescription, William & Wilkins, 9, 401.
American College of Cardiology (ACC), Digoxin (Lanoxin) Considerations for Use, acc.org, Accessed 13 Nov 2017.
Gheorghiade M, Fonarow GC, van Veldhuisen DJ, Cleland JG, Butler J, Epstein AE, Patel K, Aban IB, Aronow WS, Anker SD, Ahmed A (2013). Lack of evidence of increased mortality among patients with atrial fibrillation taking digoxin: findings from post hoc propensity-matched analysis of the AFFIRM trial.Eur Heart J. 34(20):1489-97.
Whitbeck MG, Charnigo RJ, Khairy P, Ziada K, Bailey AL, Zegarra MM, Shah J, Morales G, Macaulay T, Sorrell VL, Campbell CL, Gurley J, Anaya P, Nasr H, Bai R, Di Biase L, Booth DC, Jondeau G, Natale A, Roy D, Smyth S, Moliterno DJ, Elayi CS (2013). Increased mortality among patients taking digoxin--analysis from the AFFIRM study. Eur Heart J. 34(20):1481-8.