Michele Zito Due: 1/14/03



Drug Info Question #1 Internal Medicine Rotation

Question:

I just read something about digoxin causing an increased risk of death in women who use it for heart failure. Is this true? Is there any literature available on this subject? Should I D/C digoxin in all my female patients? Please clarify this issue.

Background Information:

Currently, digoxin is indicated for the treatment of congestive heart failure (CHF), tachyarrhythmias, and cardiogenic shock.1 Digoxin exerts a positive inotropic effect and a negative chronotropic effect. Although used for over 200 years for a variety of cardiac conditions, the safety, efficacy, and beneficial serum levels of digoxin are often questioned.2

In 1997, the results of the Digitalis Investigational Group (DIG) trial were published in the New England Journal of Medicine. This randomized, double-blind, placebo controlled clinical trial evaluated the role of digoxin in 6,800 CHF patients in terms of mortality and hospitalizations.2 These results indicated when digoxin is used concomitantly with an ACE Inhibitor and a diuretic in patients with an ejection fraction 45% or less, the only statistically significant conclusion was a reduction in the rate of overall hospitalizations and hospitalizations due to worsening CHF (26.8% in patients receiving digoxin vs. 34.7% in patients receiving placebo; risk ratio, 0.72; 95% confidence interval, 0.66 to 0.79; P ................
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