Digoxin
1. Mechanism of action :
Digoxin exerts hemodynamic, electrophysiologic, and neurohormonal effects on the cardiovascular system It
reversibly inhibits the Na-K ATPase enzyme, leading to various beneficial effects. The Na-K ATPase enzyme
functions to maintain the intracellular environment by regulating the entry and exit of sodium, potassium, and
calcium (indirectly). Na-K ATPase is also known as the sodium pump The inhibition of the sodium pump by digoxin
increases intracellular sodium and increases the calcium level in the myocardial cells, causing an increased
contractile force of the heart. This improves the left ventricular ejection fraction (EF), an important measure of
cardiac function.
NB; digoxin IS AN AC in digitalis
Digoxin also stimulates the parasympathetic nervous system via the vagus nerve leading to sinoatrial (SA) and
atrioventricular (AV) node effects, decreasing the heart ratePart of the pathophysiology of heart failure includes
neurohormonal activation, leading to an increase in norepinephrine. Digoxin helps to decrease norepinephrine
levels through activation of the parasympathetic nervous system
2. Uses:
Digoxin is used to treat heart failure, usually along with other medications.
It is also used to treat certain types of irregular heartbeat (such as chronic atrial fibrillation).
Treating heart failure may help maintain your ability to walk and exercise and may improve the strength
of your heart
Treating an irregular heartbeat can also improve your ability to exercise.
Digoxin belongs to a class of medications called cardiac glycosides.
Reduces strain on the heart and helps it maintain a normal, steady, and strong heartbeat.
3. Side effect :
Common Side effects of Digoxin include:
Dizziness
Mental disturbance
Diarrhea
Headache
Nausea
Vomiting
Red, bumpy rash
Less common side effects of digoxin include:
Loss of appetite
Irregular heartbeat
Arrhythmia in children (consider toxicity)
Visual disturbance (blurred or yellow vision)
Heart block
Cardiac arrest rhythm (asystole)
Fast heart rate
4. Contraindication:
Acute myocardial infarction
Wolf-Parkinson-White syndrome
Hypercalcemia/hypocalcemia
Hypersensitivity to the drug
Ventricular fibrillation
Myocarditis
Hypomagnesemia
Hypokalemia
Wolf-Parkinson-White syndrome
Its use requires caution in cases of:
Hypercalcemia/hypocalcemia
Renal impairment
Diseased SA node
Bradycardia
AV block
Restrictive cardiomyopathy
Constrictive pericarditis
Thyroid disease - hypothyroidism leads to delayed drug clearance, and hyperthyroidism does the opposite.
5. Digoxin may present interactions with the following:
Azole antifungals, which inhibit the transport of digoxin via human P-glycoprotein
Macrolide antibiotics, which inhibit P-glycoprotein, thus increasing intestinal drug absorption
Rifampin
Dronedarone
Loop diuretics
Quinidine
6. Method of screening:
A digoxin test is a blood test that can be use to determine the level of the medication digoxin in your
blood.
Digoxin is available in oral form. Your body absorbs it, and it then travels to your body’s tissues,
especially your heart, kidney, and liver.
Digoxin testing to make sure that you aren’t receiving too much or too little of the drug. We should
monitor the level of digoxin in your blood because the drug has a narrow safe range.
7. References:
Hershman, J. M. (2014). Subacute Thyroiditis.
[Link]/professional/endocrine-and-metabolic-disorders/thyroid-
disorders/subacute-thyroiditis
Mayo Clinic Staff. (2014). Beta blockers.
[Link]/health/beta-blockers/HI00059
Recalls, market withdrawals, and safety alerts. (2020).
[Link]
Sweeney, L. B., Stewart, C., & Gaitonde, D. Y. (2014). Thyroiditis: An integrated approach.
[Link]/afp/2014/0915/[Link]
Name: Nada Nasser Mostafa Elnaaggar
Group: 13
Number: 4701
