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101. Efficacy and safety of digoxin in patients with heart failure and reduced ejection fraction according to diabetes status: An analysis of the Digitalis Investigation Group (DIG) trial. (Full text)

Efficacy and safety of digoxin in patients with heart failure and reduced ejection fraction according to diabetes status: An analysis of the Digitalis Investigation Group (DIG) trial. Digoxin is recommended in symptomatic heart failure patients with reduced ejection fraction (HF-REF) in sinus rhythm and refractory to other evidence-based therapy. Although HF-REF patients with diabetes have worse functional status than those without, the effects of digoxin have not been specifically evaluated (...) according to diabetes status.We examined the efficacy and safety of digoxin in HF-REF patients with and without diabetes in the Digitalis Investigation Group trial. Mortality from all-cause, cardiovascular (CV) causes and heart failure (HF), along with HF hospitalisation and suspected digoxin toxicity were analyzed according to diabetes status and randomised treatment assignment.Of the 6800 patients, those with diabetes (n=1933) were older, more often women, had worse clinical status and more co

2016 International journal of cardiology PubMed

102. Digoxin toxicity: Case for retiring its use in elderly patients? (Full text)

Digoxin toxicity: Case for retiring its use in elderly patients? 26975913 2016 12 13 2018 11 13 1715-5258 62 3 2016 Mar Canadian family physician Medecin de famille canadien Can Fam Physician Digoxin toxicity: Case for retiring its use in elderly patients? 223-8 MacLeod-Glover Nora N Clinical Information Resource Specialist in the Poison and Drug Information Service at Alberta Health Services in Calgary. nora.macleod-glover@albertahealthservices.ca. Mink Matthew M Educator and Clinical (...) Article Canada Can Fam Physician 0120300 0008-350X 0 Anti-Arrhythmia Agents 73K4184T59 Digoxin IM Aged Anti-Arrhythmia Agents administration & dosage adverse effects Digoxin administration & dosage adverse effects Drug Interactions Female Humans 2016 3 16 6 0 2016 3 16 6 0 2016 12 15 6 0 ppublish 26975913 62/3/223 PMC4984589 JAMA Intern Med. 2013 Sep 9;173(16):1552-4 23797613 Br J Clin Pharmacol. 1991 Dec;32(6):717-21 1768564 JAMA. 2003 Apr 2;289(13):1652-8 12672733 Clin Pharmacol Ther. 1993 Jul;54(1

2016 Canadian Family Physician PubMed

103. Digoxin Use Is Associated With Reduced Interstage Mortality in Patients With No History of Arrhythmia After Stage I Palliation for Single Ventricle Heart Disease (Full text)

Digoxin Use Is Associated With Reduced Interstage Mortality in Patients With No History of Arrhythmia After Stage I Palliation for Single Ventricle Heart Disease Interstage mortality (IM) remains significant after stage 1 palliation (S1P) for single-ventricle heart disease (SVD), with many deaths sudden and unexpected. We sought to determine whether digoxin use post-S1P is associated with reduced IM, utilizing the multicenter database of the National Pediatric Cardiology Quality Improvement (...) Collaborative (NPCQIC).From June 2008 to July 2013, 816 infants discharged after S1P from 50 surgical sites completed the interstage to stage II palliation, transplant, or IM. Arrhythmia during S1P hospitalization or discharge on antiarrhythmic medications were exclusions (n=270); 2 patients were lost to follow-up. Two analyses were performed: (1) propensity-score adjusted logistic regression with IM as outcome and (2) retrospective cohort analysis for patients discharged on digoxin versus not, matched

2016 Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease PubMed

104. Calorie Restriction Increases P-Glycoprotein and Decreases Intestinal Absorption of Digoxin in Mice (Full text)

Calorie Restriction Increases P-Glycoprotein and Decreases Intestinal Absorption of Digoxin in Mice There is wide variation in how patients respond to therapeutics. Factors that contribute to pharmacokinetic variations include disease, genetics, drugs, age, and diet. The purpose of this study was to determine the effect of calorie restriction on the expression of Abcb1a in the intestine and whether calorie restriction can alter the absorption of an Abcb1a substrate (i.e., digoxin) in mice. Ten (...) -week-old C57BL/6 mice were given either an ad libitum diet or a 25% calorie-restricted diet for 3 weeks. To determine digoxin absorption, mice were administered [(3)H]-labeled digoxin by oral gavage. Blood and intestine with contents were collected at 1, 2, 4, and 12 hours after digoxin administration. Concentrations of [(3)H]-digoxin in plasma and tissues were determined by liquid scintillation. Calorie restriction decreased plasma digoxin concentrations (about 60%) at 1, 2, and 4 hours after

2016 Drug Metabolism and Disposition PubMed

105. Digoxin reduces atherosclerosis in apolipoprotein E‐deficient mice (Full text)

Digoxin reduces atherosclerosis in apolipoprotein E‐deficient mice Numerous in vitro studies have suggested that digoxin suppresses inflammation and alters lipid metabolism. However, the effect of dioxin on atherosclerosis is poorly understood. The present study was conducted to determine whether digoxin affects the development of atherosclerosis in a murine model of atherosclerotic disease.Apolipoprotein E-deficient mice maintained on a Western-type diet were administered PBS (control), low (...) -dose digoxin (1 mg · kg(-1) · day(-1)) or high-dose digoxin (2 mg · kg(-1) · day(-1)) via i.p. injection for 12 weeks.Digoxin dose-dependently reduced atherosclerotic lesion formation and plasma lipid levels (reductions of 41% in total cholesterol, 54% in triglycerides and 20% in low-density lipoprotein cholesterol in the high-dose digoxin-treated group). Moreover, treatment with digoxin markedly attenuated IL-17A expression and IL-17A-related inflammatory responses and increased the abundance

2016 British journal of pharmacology PubMed

106. Unravelling the complex drug–drug interactions of the cardiovascular drugs, verapamil and digoxin, with P-glycoprotein (Full text)

Unravelling the complex drug–drug interactions of the cardiovascular drugs, verapamil and digoxin, with P-glycoprotein Drug-drug interactions (DDIs) and associated toxicity from cardiovascular drugs represents a major problem for effective co-administration of cardiovascular therapeutics. A significant amount of drug toxicity from DDIs occurs because of drug interactions and multiple cardiovascular drug binding to the efflux transporter P-glycoprotein (Pgp), which is particularly problematic (...) for cardiovascular drugs because of their relatively low therapeutic indexes. The calcium channel antagonist, verapamil and the cardiac glycoside, digoxin, exhibit DDIs with Pgp through non-competitive inhibition of digoxin transport, which leads to elevated digoxin plasma concentrations and digoxin toxicity. In the present study, verapamil-induced ATPase activation kinetics were biphasic implying at least two verapamil-binding sites on Pgp, whereas monophasic digoxin activation of Pgp-coupled ATPase kinetics

2016 Bioscience reports PubMed

107. Discontinuation of paediatric injectable digoxin: A loss for optimal drug therapy in children (Full text)

Discontinuation of paediatric injectable digoxin: A loss for optimal drug therapy in children In early 2015, the paediatric formulation of injectable digoxin (50 μg/mL) was discontinued in Canada. The only remaining injectable formulation is five times more concentrated. This recent event has major implications for paediatric hospitals all over the country. The use of a more concentrated formulation is of particular concern in low-weight infants because the required volumes of digoxin (...) are almost impossible to draw precisely. Such a situation is problematic because of the narrow therapeutic index of digoxin. There are different ways to deal with this inconvenient situation; however, none is as efficient or safe for infants as the discontinued formulation. The authors believe it remains imperative that patients requiring intravenous digoxin be treated with the safest and most efficient formulation possible, regardless of their age or size.

2016 Paediatrics & child health PubMed

108. Digoxin Toxicity

Digoxin Toxicity Digoxin Toxicity Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Digoxin Toxicity Digoxin Toxicity Aka: Digoxin (...) Toxicity , Digitalis Toxicity , Digibind , Digoxin-Immune Fab From Related Chapters II. Epidemiology Digoxin Toxicity was common with standard dose ( 7-20%) Lower doses used since in the U.S. has resulted in decreased toxicity III. Risk Factors Medication use interfering with excretion IV. Symptoms Yellow vision (xanthopsia) V. Signs VI. Labs Serum Level over 2.5 mg/ml Does not always correlate with toxicity Toxicity may occur at low levels and not at high ones Dysrhythmia Premature beats Bigeminy

2018 FP Notebook

109. Digoxin

Digoxin Digoxin Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Digoxin Digoxin Aka: Digoxin , Lanoxin , Digitalis , Digitalis (...) Glycoside From Related Chapters II. History Derived from Foxglove (Digitalis) plant Originally used as herbal tea to cure " " First described by William Withering, England, 1775 III. Precautions Chronic Do not need to routinely follow Digoxin levels See Indications for Digoxin levels below Acute management (not recommended) High risk in critically ill patient Parenteral inotropes are preferred over Digoxin More potent Less toxicity (not recommended) Avoid Digoxin for outside of comorbid CHF Increased

2018 FP Notebook

110. Extracorporeal treatment for digoxin poisoning: systematic review and recommendations from the EXTRIP Workgroup. (PubMed)

Extracorporeal treatment for digoxin poisoning: systematic review and recommendations from the EXTRIP Workgroup. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatments (ECTR) in poisoning. Here, we present our results for digoxin.After a systematic literature search, clinical and toxicokinetic data were extracted and summarized following a predetermined format. The entire workgroup voted through a two-round (...) , including six fatalities, it was concluded that digoxin is slightly dialyzable (level of evidence = B), and that ECTR is unlikely to improve the outcome of digoxin-toxic patients whether or not digoxin immune Fab (Fab) is administered. Despite the lack of robust clinical evidence, the workgroup recommended against the use of ECTR in cases of severe digoxin poisoning when Fab was available (1D) and also suggested against the use of ECTR when Fab was unavailable (2D).ECTR, in any form, is not indicated

2016 Clinical toxicology (Philadelphia, Pa.)

111. Extracorporeal treatment for digoxin toxicity: just say no

Extracorporeal treatment for digoxin toxicity: just say no Extracorporeal treatment for digoxin toxicity: just say no » The Poison Review Extracorporeal treatment for digoxin toxicity: just say no January 28, 2016, 3:42 pm Extracorporeal treatment for digoxin poisoning: systematic review and recommendations from the EXTRIP Workgroup. Mowry JB et al. Clin Toxicol 2016 Feb;54:103-14. “Forced diuresis, and hemodialysis are ineffective in enhancing the elimination of digoxin because of its large (...) volume of distribution (4-10 L/kg), which makes it relatively inaccessible to these techniques.” Goldfrank’s Toxicologic Emergencies (Tenth Edition, 2015) That one sentence from the latest edition of Goldfrank’s tells you all you need to know about the use of extracorporeal treatment (ECTR) in digoxin poisoning, and makes this current paper from the somewhat superfluous. To cut to the chase (no spoiler alert needed), the conclusions here agree completely: ECTR, in any form, is not indicated

2016 The Poison Review blog

112. A New Method for Individualized Digoxin Dosing in Elderly Patients. (PubMed)

A New Method for Individualized Digoxin Dosing in Elderly Patients. Digoxin is a frequently prescribed drug in the elderly population. Estimated glomerular filtration rate is widely used to adjust dosages. The HUGE value is a tool for differentiating the presence or absence of chronic kidney disease in elderly patients. We aimed to investigate the usefulness of the HUGE value to predict the initial dose of digoxin in patients aged older than 70 years.We reviewed retrospectively the medical (...) records of patients aged older than 70 years with serum digoxin concentrations (SDCs) monitored over a 6-month period (63 patients). A linear regression relating the patient's SDC, maintenance dose of digoxin and the HUGE value was estimated to generate a dosage equation. This equation was validated retrospectively (33 patients) and prospectively (35 patients) in comparison with two existing methods based on creatinine clearance.An equation (HUGE_DIG) was generated to calculate the initial digoxin

2016 Drugs & Aging

113. Flecainide versus digoxin for fetal supraventricular tachycardia: Comparison of two drug treatment protocols. (PubMed)

Flecainide versus digoxin for fetal supraventricular tachycardia: Comparison of two drug treatment protocols. The optimal treatment for fetal supraventricular tachycardia (SVT) with 1:1 atrioventricular relationship is unclear.We compared the effectiveness of transplacental treatment protocols used in 2 centers.Pharmacologic treatment was used in 84 fetuses. Maternal oral flecainide was the primary therapy in center 1 (n = 34) and intravenous maternal digoxin in center 2 (n = 50). SVT mechanism (...) was classified by mechanical ventriculoatrial (VA) time intervals as short VA or long VA. Treatment success was defined as conversion to sinus rhythm (SR), or rate control, defined as >15% rate reduction.Short VA interval occurred in 67 fetuses (80%) and long VA in 17 (20%). Hydrops was present 28 of 84 (33%). For short VA SVT, conversion to SR was 29 of 42 (69%) for digoxin and 24 of 25 (96%) for flecainide (P = .01). For long VA SVT, conversion to SR and rate control was 4 of 8 (50%) and 0 of 8

2016 Heart Rhythm

114. Digoxin therapy for cor pulmonale: A systematic review. (PubMed)

Digoxin therapy for cor pulmonale: A systematic review. Right heart failure is associated with increased mortality and morbidity. The optimal treatment for patients with RV failure is not established. The aim of this study is to conduct a systematic review of the literature to assess the relative benefits and harms of digoxin therapy in patients with RV failure.We performed a literature search in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) on Nov. 4, 2014. We (...) did not use publication type, period or language restrictions to the search strategy. Exclusions included: trials that excluded patients with RV failure, included patients requiring mechanical or intravenous inotropic support, review papers and case reports. The primary outcome was long-term efficacy outcomes of digoxin in right heart failure. Two reviewers screened titles and abstracts of identified citations independently and in duplication using calibration exercises and standardized screening

2016 International journal of cardiology

115. Use of digoxin and risk of death or readmission for heart failure and sinus rhythm: A nationwide propensity score matched study. (PubMed)

Use of digoxin and risk of death or readmission for heart failure and sinus rhythm: A nationwide propensity score matched study. Digoxin is widely used as symptomatic treatment in heart failure (HF), but the role in contemporary treatment of HF with sinus rhythm (SR) is debatable. We investigated the risk of death and hospital readmission, according to digoxin use, in a nationwide cohort of digoxin-naïve patients with HF and SR.From Danish nationwide registries, digoxin-naïve HF patients from (...) 1996 to 2012 were identified. Patients with cardiac dysrhythmias or use of warfarin were excluded. Digoxin users and non-users were compared in propensity matched cox regression models with respect to primary outcomes of all-cause mortality and HF readmission.The study population comprised 5327 digoxin users and 10,654 matched non-users with a median age of 77. During follow-up 10,643 (66.6%) patients died and 7584 (47.5%) patients were readmitted due to HF. Use of digoxin was associated

2016 International journal of cardiology

116. The effect of 17α-ethynylestradiol induced intrahepatic cholestasis of pregnancy on placental P-glycoprotein in mice: Implications in the individualized transplacental digoxin treatment for fetal heart failure. (PubMed)

The effect of 17α-ethynylestradiol induced intrahepatic cholestasis of pregnancy on placental P-glycoprotein in mice: Implications in the individualized transplacental digoxin treatment for fetal heart failure. Placental P-glycoprotein (P-gp) plays a significant role in controlling transplacental digoxin transfer rate. Investigations on P-gp regulation in placenta of women with different pregnant pathological states are of great significance to individualized transplacental digoxin treatment (...) cholestasis. Placental Abcb1a/Abcb1b/HIF-1α mRNA and P-gp/HIF-1α protein expression were determined by real-time quantitative PCR and western-blot. Maternal plasma and fetal-unit digoxin concentrations were detected by a commercial kit assay.The ICP group showed higher levels of maternal plasma ALT, AST, TB, DBIL, γ-GT, LDH, ALP and TBA concentrations, reduction in fetal survival rates, lower placental and fetal weights, and typical liver cells degeneration, necrosis and intrahepatic cholestasis

2016 Placenta

117. Addition of beta-blockers to digoxin is associated with improved 1- and 10-year survival of patients hospitalized due to decompensated heart failure. (PubMed)

Addition of beta-blockers to digoxin is associated with improved 1- and 10-year survival of patients hospitalized due to decompensated heart failure. Many of the studies associating digoxin use with increased mortality were conducted before beta-blockers became a standard therapy for heart failure (HF) patients. Our goal was to determine the effect of beta-blockers on the prognosis of patients hospitalized for decompensated HF who receive digoxin therapy at discharge.We analyzed 2402 patients (...) admitted with a primary diagnosis of decompensated HF during the prospective National Heart Failure Survey in Israel. Multivariate modeling was used to determine the effect of beta-blockers and digoxin on 1- and 10-year survival.Patients discharged on digoxin and beta-blockers (DIG+/BB+) had a lower 1-year mortality rate than those discharged on digoxin alone (DIG+/BB-), (31% vs. 44%; p<0.001). Digoxin administration was associated with an increase in adjusted 1-year (Hazard ratio [HR] 1.28; 95

2016 International journal of cardiology

118. Rare Manifestation of Digoxin Toxicity: Right Bundle Branch Block (Full text)

Rare Manifestation of Digoxin Toxicity: Right Bundle Branch Block A 76-year-old female, with medical history significant for systolic congestive heart failure, who presented to the emergency department with lethargy and abdominal pain with diarrhea for the past 3 weeks. Due to hypotension, the patient received multiple boluses of isotonic saline and was started on norepinephrine. Laboratories were significant for severe digoxin toxicity (29 ng/mL), in setting of acute kidney injury (...) . Electrocardiogram (EKG) revealed a new right bundle branch block (RBBB). She was given Digibind and her repeat digoxin level was 20 ng/mL. Repeat EKG showed resolved RBBB. This case identifies that patients with digoxin toxicity are at risk for RBBB. This is a rare finding and is not commonly recognized. Emergency medicine physicians are often the first to encounter patients with digoxin toxicity and need to be aware of such EKG findings.

2016 Journal of basic and clinical pharmacy PubMed

119. Management of digoxin toxicity (Full text)

Management of digoxin toxicity Digoxin toxicity can emerge during long-term therapy as well as after an overdose. It can occur even when the serum digoxin concentration is within the therapeutic range. Toxicity causes anorexia, nausea, vomiting and neurological symptoms. It can also trigger fatal arrhythmias. There is a range of indications for using digoxin-specific antibody fragments. The amount ingested and serum digoxin concentration help to determine the dose required (...) , but are not essential. Digoxin-specific antibody fragments are safe and effective in severe toxicity. Monitoring should continue after treatment because of the small risk of rebound toxicity. Restarting therapy should take into account the indication for digoxin and any reasons why the concentration became toxic.

2016 Australian Prescriber PubMed

120. Effects of digoxin on cardiac iron content in rat model of iron overload (Full text)

Effects of digoxin on cardiac iron content in rat model of iron overload Plasma iron excess can lead to iron accumulation in heart, kidney and liver. Heart failure is a clinical widespread syndrome. In thalassemia, iron overload cardiomyopathy is caused by iron accumulation in the heart that leads to cardiac damage and heart failure. Digoxin increases the intracellular sodium concentration by inhibition of Na+/K+-ATPase that affects Na+/Ca2+ exchanger (NCX), which raises intracellular calcium (...) and thus attenuates heart failure. The mechanism of iron uptake into cardiomyocytes is not exactly understood.We assessed the effect of different concentrations of digoxin on cardiac iron content in rat model of iron overload. Digoxin had been administrated intraperitoneally (IP) for one week before main study began to assure increased digoxin levels. Group 1 received four IP injections of iron-dextran (12.5mg/100g body weight) every 5 days evenly distributed over 20 days. Groups 2-4 received 0.5, 1

2016 ARYA atherosclerosis PubMed

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