Dr. Fett and digoxin/lanoxin

[momofthree]

Dr. Fett,

I just scanned the archives. First of all, you are so generous to keep up with this site and to take so much time and put such thoughtfulness into your replies. Thank you so much.

I read about your thoughts on digoxin and that we should try to avoid using it. I am on digoxin 0.125 mg. Do you have the same thoughts as before? It is a low dose and it is checked every month or so. I guess I was a last case type patient for awhile. I was on IV milrinone and prevnar (or are those the same and I am forgetting the other name?) and was on dobutamine at one time. Plus oral meds, too. Anyway, I have an appt. on 4 April with my cardiologist. Should I talk to him about this? My ECHO is that day, too and who knows what that will lead to. He wants to take me off coumadin if my function is increased.

When you have time...thanks much. Alison

[JAMESFETT]

Yes, Alison, my thoughts are the same as the previous posting. Digoxin is one of last medications we go to, and it is one of the first to discontinue when improvement occurs. There has to be a specific extra indication to use Digoxin, since the other medications (ACE-inhibitor and beta blocker and diuretics) are so effective and have a larger safety margin. One of the specific indications is to control the rate in atrial fibrillation. Digoxin has never been shown in studies to give any benefit in terms of survival. On the contrary, in women, it has been shown to carry a small, but significant, risk of mortality, as compared to the use of digoxin in men. This is why digoxin is being used much less frequently in the treatment of PPCM and CHF. It is an issue worth reviewing with your physician. And in the final analysis each person is different and each patient must be evaluated on the basis of her own situation.

James