Digoxin Use in Modern Medicine

Shan Chen, PharmD Candidate; Troy Khusial, PharmD Candidate; Dipen Patel, PharmD Candidate; Satinder Singh, PharmD Candidate; Tatyana Yakubova, PharmD Candidate; Amy Wang, PharmD, BCPS, MBA; Timothy Nguyen, PharmD, BCPS, CCP, FASCP


US Pharmacist. 2015;40(2):44-48. 

In This Article

Digoxin and HF

CHF is a myocardial dysfunction caused by the contractile performance of the heart, ventricular relaxation/filling of the heart, or both. In CHF, contractility is decreased, which in turn reduces cardiac output. Digoxin is effective in patients with CHF because of its positive inotropic properties. Although studies have shown that digoxin reduces hospitalizations and improves symptoms of HF, it has not been proven to decrease mortality.

Digoxin's role in HF has been assessed in numerous trials. One double-blind, controlled trial of digoxin for CHF treatment randomized subjects with cardiac dysfunction to digoxin or placebo for 7 weeks.[8] Placebo subjects deteriorated more quickly than those taking digoxin. Cardiac function, as measured by ejection fraction (EF), was significantly improved in digoxin patients.[8] Many other clinical trials showed that digoxin's positive inotropic effects were useful in the management of CHF.

According to the 2013 American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guideline on managing HF, digoxin improves symptoms, quality of life, and exercise tolerance in patients with mild-to-moderate HF, regardless of the underlying rhythm (normal sinus rhythm or AF).[5] Therefore, digoxin may be considered as add-on therapy for patients who have persistent symptoms of HF despite treatment with ACEI/ARBs and/or beta-blockers. Digoxin may also be considered in patients with stage C HF (structural heart disease with prior or current symptoms of HF) or stage D HF (HF symptoms at rest and recurrent hospitalizations despite therapy). HF patients should not take digoxin without an ACEI or beta-blocker. Although digoxin is prescribed for patients with HF and AF, concomitant beta-blocker therapy is usually more effective at controlling ventricular response, particularly during exercise.[5,6]

The initial dosage of digoxin is 0.125 mg to 0.25 mg by mouth daily. The dosage must be adjusted based on renal function and age (Table 1). The target serum level of digoxin in HF is 0.5 ng/mL to 0.9 ng/mL.[5]