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Digoxin useful … with restrictions

Low doses for rhythm control may be safe, doctors say.

Digoxin is a medication often used to treat atrial fibrillation, one of the most common heart rhythm disturbances. This disorder causes the heart to beat rapidly and irregularly. Digoxin lowers the heart rate and helps bring it under control.

Although digoxin has been used by millions of people over the years, doctors have been concerned about its safety for decades. The safety issue arose again after the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial results were published in the Nov. 27, 2012, European Heart Journal. This trial concluded that digoxin increased the risk of death. Dr. Peter Zimetbaum, a heart rhythm specialist at Harvard-affiliated Beth Israel Deaconess Medical Center, says that this trial reaffirms the need for caution when using digoxin, but does not change his practice. “There is simply no good alternative to it for some people,” he says. “Digoxin should be used carefully and in as low a dose as possible.”

Using digoxin safely

Digoxin is not an easy drug to use. A little goes a long way. According to Dr. Zimetbaum, there are two key rules:

Use it sparingly. “The difference between benefit and toxicity can be small,” he says. When you raise the dose, the drug can cause a wide range of side effects, as well as interactions with other medications. “High doses of this medicine can be quite dangerous, particularly in people with abnormal kidney function and in older people,” he says.

Use it as a second drug. The first drug of choice for atrial fibrillation is a beta blocker or calcium-channel blocker. Low-dose digoxin should be added only when the heart rate needs to be lowered further.

Of course, there are exceptions. Because digoxin does not affect blood pressure, it is sometimes used alone in a person with atrial fibrillation who has naturally low blood pressure. But these cases are rare. “Sometimes, there is no other effective rate-controlling treatment that doesn’t also lower blood pressure. We will have to have more data before we remove digoxin from the list of drugs we use to control heart rate in atrial fibrillation,” says Dr. Zimetbaum.

Posted by: Dr.Health

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