title: Role of Digoxin in Atrial Fibrillation.
abstract: Since its isolation in the 1930s, digoxin has played a pivotal role in the treatment of cardiac conditions including heart failure and supraventricular tachyarrhythmias. The parasympathomimetic activity makes digoxin a reasonable option for controlling ventricular rate in atrial fibrillation (AF). However, the unique pharmacokinetic properties, electrolyte-dependent effects, and P-glycoprotein drug interactions influence the clinical use of digoxin. In addition, the delayed onset and narrow therapeutic index can make digoxin utilization cumbersome and often necessitates serum drug monitoring. Despite digoxin's extensive history, recent literature has cast doubt on the efficacy and safety of this medication in the population with AF. Large amounts of data suggest digoxin offers no benefit on mortality and may increase the risk of mortality though this was not consistent in all evaluations. While robust, the majority of the available studies are not randomized which limits the ability to draw firm conclusions. The potential risk of mortality must be weighed against the expected benefits of digoxin use to make individualized patient care decisions. Clinicians should refrain from utilizing digoxin monotherapy for rate control in AF when other options are viable.
authors.affiliation: 1 Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Mobile, AL, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Scalese
authors.affiliation: 2 Division of Pharmacy Practice and Administration, University of Missouri-Kansas City, Kansas City, MI, USA.
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Salvatore
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy*; D004077:Digoxin / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy; D006801:Humans
chemical_list: D000889:Anti-Arrhythmia Agents; D004077:Digoxin
keywords: atrial fibrillation; digoxin; review