Cardiac glycosides in the next millennium.
Despite the documented efficacy of cardiac glycosides in improving symptoms in patients with heart failure caused by systolic ventricular dysfunction, considerable debate continues as to whether the use of this class of drugs should continue into the next millennium. In this review, the authors briefly examine the basic pharmacology of these drugs relevant to the treatment of heart failure, emphasizing their role in reducing sympathetic nervous system activity in patients with advanced heart failure. Next, withdrawal trials and the Digoxin Investigation Group dataset are reviewed in some detail. Despite these important additional data on the safety and efficacy of digitalis use in heart failure that became available in the 1990s, considerable controversy remains. Perhaps most importantly, if the mechanism by which these drugs improve symptoms in patients with heart failure is principally mediated by sympatholytic activity, do they remain relevant as beta-adrenergic antagonists become standard therapy for this disease?
Hauptman
P J
PJ
Cardiology Division, Saint Louis University Hospital and Saint Louis University School of Medicine, MO, USA.
Garg
R
R
Kelly
R A
RA
D002301:Cardiac Glycosides / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004077:Digoxin / Q000627:therapeutic use; D011307:Drug Prescriptions; D006321:Heart / Q000294:innervation / Q000503:physiopathology; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000503:physiopathology; D016896:Treatment Outcome
D002301:Cardiac Glycosides; D002316:Cardiotonic Agents; D004077:Digoxin