Digoxin congestive heart failure

GC Oliver, R Tazman, R Frederickson. Influence of congestive heart failure on digoxin level. In O Storstein, ed. Symposium on Digitalis. Oslo Gyl-dendal Norsk Forlag, 1973, pp. 336-347. 

A 75-year-old female in congestive heart failure (CHF) is unable to climb a flight of stairs without experiencing shortness of breath. Digoxin is administered to improve cardiac muscle contractility. Within two weeks, she has a marked improvement in her symptoms. What cellular action of digoxin accounts for this ... 

Nagai Y, Hayakawa T, Abe T, Nomura G. Are there different effects of acarbose and voglibose on serum levels of digoxin in a diabetic patient with congestive heart failure Diabetes Care 2000 23(11) 1703. 

Roberge RJ, Sorensen T. Congestive heart failure and toxic digoxin levels role of cholestyramine. Vet Hum Toxicol 2000 42(3) 172-3. 

Kjeldsen K, Norgaard A, Gheorghiade M. Myocardial Na, K-ATPase the molecular basis for the hemodynamic effect of digoxin therapy in congestive heart failure. Cardiovasc Res 2002 55 710-713. 

A 77-year-old woman developed extreme fatigue, anorexia, psychomotor retardation, and social withdrawal 1 month after starting to take digoxin 0.5 mg/day for congestive heart failure (88). She did not respond to intravenous clomipramine 25 mg/day for 7 months. Her serum digoxin concentration was 3.2 ng/ml. Digoxin... 

The pharmacokinetics of digoxin have been studied in 181 neonates and children with and without congestive heart failure (142). The clearance rate was lower in premature neonates than in neonates bom at full term. Children with congestive heart failure also had lower digoxin clearance. 

A population pharmacokinetic study in 172 neonates and infants showed that the clearance of digoxin is affected significantly by total body weight, age, renal function, and congestive heart failure (143). 

An 81-year-old woman with congestive heart failure and hypercalcemia secondary to squamous cell carcinoma of the bronchus developed first-degree heart block and symptomatic sinus pauses when her serum digoxin concentration was only 1.5 mg/ml (152). 

Colestyramine has been used for the same purpose. In two elderly patients with congestive heart failure and raised serum digoxin concentrations it enhanced the elimination of digoxin (172). In one case the half-hfe of digoxin was 20 hours and in the other 24 hours. 

Drug interactions with cardiac glycosides can be subdivided into six types, according to mechanism. Interactions with digoxin have been reviewed (SEDA-6, 173) (196-198). Drug interactions with digitoxin have been briefly reviewed in the context of its use in the treatment of congestive heart failure (199). 

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