Summary
Digoxin (better known as Digitalis), sold under the brand name Lanoxin among others, is a medication used to treat various heart conditions. Most frequently it is used for atrial fibrillation, atrial flutter, and heart failure. Digoxin is one of the oldest medications used in the field of cardiology. It works by increasing myocardial contractility, increasing stroke volume and blood pressure, reducing heart rate, and somewhat extending the time frame of the contraction. Digoxin is taken by mouth or by injection into a vein. Digoxin has a half life of approximately 36 hours given at average doses in patients with normal renal function. It is excreted mostly unchanged in the urine. Common side effects include breast enlargement with other side effects generally due to an excessive dose. These side effects may include loss of appetite, nausea, trouble seeing, confusion, and an irregular heartbeat. Greater care is required in older people and those with poor kidney function. It is unclear whether use during pregnancy is safe. Digoxin is in the cardiac glycoside family of medications. It was first isolated in 1930 from the foxglove plant, Digitalis lanata. It is on the World Health Organization's List of Essential Medicines. In 2020, it was the 237th most commonly prescribed medication in the United States, with more than 1 million prescriptions. The most common indications for digoxin are atrial fibrillation and atrial flutter with rapid ventricular response, especially in older or less active patients, though beta blockers and/or calcium channel blockers may be preferred in some patients, such as younger more active ones, or those without heart failure or hemodynamic instability. Early observational studies showed an increased the risk of death in patients taking digoxin, despite an attempt to allow for other risk factors for death (so-called propensity score matching). However, systematic reviews focusing on randomised controlled trials of digoxin (which ensured similarity between patients on digoxin, and those not on it) showed no difference in mortality.
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