Role of digoxin/weight loss

[LauraNP]

Hi Dr. Fett,
I have a question.. I think I understand this correctly but I want to make sure.

Digoxin does not improve ventricular remodeling or do anything to help EF, it only helps symptoms? I know it also is supposed to lower HR and is a weak anti arrythmic. Is this true?

So what is the role of digoxin in the stable DCM patient with a stable EF and no symptoms? My cardiologist told me I could stop it if I wanted to but I want to make sure I'm not missing anything.

Also, I have recently lost 25 lbs and am having a difficult time with lightheadedness and feeling overmedicated. I talked to her about this and she suggested decreasing my enalapril. I have cut from 30 mg/day to 20mg/day and I think I am a little better. But I'm troubled by the fact that you should be on the maximum dose tolerated for maximum efficacy and I'm afraid that my taking less meds I am preventing my EF from potentially improving.. my cardiologist told me that a therapeutic dose for someone who weighs less might be 20 mg as opposed to 40 mg for a big person.. is that true?

Thanks!
Laura

[JAMESFETT]

From my perspective, I'll provide clarification to the extent that I am able, remembering that the use of digoxin is controversial, meaning there are a variety of opinions about it. I only use digoxin in PPCM or IDCM if 1)the EF is at 25 % or less, and not on the upswing. It is a positive inotropic agent, meaning that it does increase the force of muscle contraction in the heart, thereby potentially increasing LV EF; or 2)there is a heart rhythm problem, such as atrial flutter/fibrillation, for which the digoxin provides slowing of rate. I worry about the use of digoxin because of its relatively narrow range of safety, meaning the difference between help and harm, since toxicity can cause serious ventricular tachyarrhythmias. Also in PPCM, there is evidence from experimental animal studies that digoxin increases proinflammatory cytokines, which lead to decreased heart function, and that is a process going on in PPCM (an inflammatory cardiomyopathy), so best to avoid that risk. So far as the ACE-I, it is true that consideration should be given to body size in dosing. Whenever one decreases dosages of these meds, it is good to follow closely the LV EF by echo, and if it decreases, then best to go back to the larger dosage that was well-tolerated. You are receiving good advice and good care, so work with your cardiologist on this. Best wishes.

JD