Tag Archives: digoxin

In the first article, Xanniedes et al. take a look back at the major scientific advances that have led to our current understanding and medical use of digoxin. From ancient wisdom and William Withering’s careful chronicling of the therapeutic benefits and side effects of the common botanical foxglove in dropsy, which still hold true today, to the discovery of its mode of action and eventual rise to become a staple in the management of heart failure (HF) and atrial fibrillation (AF) in the pre-angiotensin-converting enzyme (ACE) inhibitor era. In parallel, the authors highlight a more macabre side to the digoxin story, including issues with

From folklore to botany to medicine to art Botany may be considered the predecessor of modern pharmacopoeia: in antiquity, a number of plants served as therapeutic remedies.1 The earliest use of foxglove can be traced back to the Greek and Roman eras, based on reports that the ‘father of pharmacognosy,’ Pedanius Dioscorides, was aware of its effects.2 In Welsh and Irish folklore, foxglove was considered to protect against the evil eye and witchcraft.3 The first detailed account of the medicinal use of foxglove took place in the sixteenth century when Leonhard Fuchs (1501–1566) suggested that it may have diuretic properties when taken or

Introduction Following its discovery and introduction for clinical use in Birmingham, UK almost 250 years ago, digoxin has been used for the treatment of heart failure (HF). Indeed, until the advent of diuretics in the 1950s, it was the only available drug for this condition.1 Digoxin is an unusual drug in many respects. Derived from the foxglove plant, it increases intracellular Ca2+, and as an oral inotrope, is the only drug for chronic use in HF that addresses the primary problem, namely reduced cardiac pumping capacity (figure 1). All the other commonly used drugs for HF act indirectly to either inhibit the adverse neurohormonal response

Laboratory testing of digoxin levels Laboratories in the National Health Service (NHS) acute trusts will have arrangements in place for routine therapeutic drug level monitoring of digoxin. Routine assays may not be available on a daily basis. However, local arrangements should exist to ensure the availability of urgent testing in cases of suspected digoxin toxicity 24 hours a day. One commonly used method is the electro-chemiluminescence immunoassay (Roche ECLIA®). This assay involves adding a combination of Ruthenium-labelled digoxin-specific monoclonal antibodies, a digoxin derivative labelled with biotin, and a fluorescent marker attache

This issue, we have a little teaser for GPs, who may reasonably come across this kind of electrocardiogram (ECG) any day of the week. Figure 1 shows the ECG of a well, 83-year-old woman, who attended her GP’s surgery for her ‘annual review’. As part of this review, the practice nurse carried out a routine ECG. Figure 1. The electrocardiogram obtained during the annual review Believe or not, it’s possible to answer the following three questions from this ECG: Q1: What chronic condition was being monitored at her annual review? Q2: What is she taking for this condition? Q3: What action should the GP take now? Let’s go through the ECG

X-VERT: rivaroxaban▼ an alternative to VKA in cardioversion for AF Watch Professor Keith Fox, Chairman of the ESC programme committee discussing the relevance of X-VERT and other studies for UK practice in our podcast from the ESC Oral anticoagulant therapy with rivaroxaban is an alternative to vitamin K antagonists (VKAs) in patients with AF who are undergoing elective cardioversion according to the results of the X-VERT study.1 In addition, rivaroxaban may potentially have one important advantage over VKAs, with a shorter time to cardioversion, the study suggests. Professor Riccardo Cappato (University of Milan, Italy), the co-principal

National survey of patients with AF in the acute medical unit: a day in the life survey Dear Sirs, The first national survey examining the management of atrial fibrillation (AF) within acute medical units up and down the country has just been published in the British Journal of Cardiology.1 Essentially it seems to show that secondary care is just as bad as primary care in initiating warfarin for AF patients. This group of patients is five times more likely to have a thromboembolic cerebrovascular accident than matched populations in sinus rhythm and yet doctors are ineffective at influencing change. This study took place over a 24-hour period

Introduction Atrial fibrillation (AF) is the most common cardiac dysrrhythmia, whose sequelae include stroke, heart failure and poor quality of life.1 In parallel with an ageing population, the prevalence of AF is increasing, with persistent or permanent forms affecting 10–15% of the population over the age of 75 years.2-6 The effective management of AF has been a source of recurring debate, leading to the publication of combined American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ESC), and National Institute for Health and Clinical Excellence (NICE) guidelines in 2006.7,8 In addition to evidenc

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