Ectopic beats and Digoxin

[Yvonne]

Last week, after a very busy time, I was suffering from a lot of ectopic beats. I didn't feel well and took more rest. This helped because gradually I felt better.
Coincidently, I also have decreased my dosage of Digoxin (because next week my BB will be increased and in the past this dosage gave bradycardia in combination with Digoxin, so I had to go back before). Suprisingly enough, after decreasing the Digoxin my bloodpressure has increased (108/ 65 instead of 95/ 60) and my ECG two days ago didn't show any ectopic beats. I am wondering: Can there be a relationship between decreasing Digoxin and ectopic beats. Or is it just a welcome coincidence?
For now I'm really happy with it.

[JAMESFETT]

It's an important point, particularly because in most cases digoxin use is neither necessary nor helpful. Digoxin is a medication with a narrow margin of safety. One of the early signs of toxicity can be increased ventricular irritability, in the form of premature ventricular contractions (a form of "ectopic" beats). Higher toxicities lead to dangerous rhythm disturbances, including ventricular tachycardia and fibrillation. Most often, in those continuing with use of digoxin the safer dosage is 0.125 mg per day, not 0.25 mg per day. One also needs to consider the reason for being on digoxin. If it is to control the rate of atrial fibrillation that may be a reason to continue. Otherwise, evidence suggests there is no other advantage for the long-term continuation of digoxin. In addition, statistically, there is evidence of increased toxity in women, with a slightly higher mortality rate for those taking digoxin, controlling for all other variables. Digoxin has never been shown to reduce mortality rates, and at best, it has been associated with reduced number of re-hospitalizations, but that is generally in the older, ischemic heart disease population. Evidence-based cardiology guidelines for the use of digoxin do not list it as a first-line medication in treatment regimens. Digoxin users are wise to review the need for digoxin in their regimen with their physicians. I find that most of my PPCM patients do very well without ever having to use digoxin, and for those who do I find they can stop using it only a few weeks to months into their treatment.

JD

JD

[Kelly]

Thanks for the info Dr. Fett. I will be sure to ask my cardiologist if I really need it at my next appointment.

[Yvonne]

Dr. Fett,
Thank you for your clear explanation. This, and the shown effects in my case, supports for my the idea of asking to stop using Digoxin completely (I'm still on a tiny dosage 0.0625 mg).