Digoxin Holiday

M. Mardikar, N. Khandekar
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Abstract

Digoxin is used in clinical practice for two major purposes: To improve ventricular performance in heart failure with reduced ejection fraction and to control the ventricular rate in atrial fibrillation. It is a cardiac glycoside with a positive inotropic effect and causes atrioventricular nodal inhibition through vagomimetic effect. It also decreases the sympathetic drive generated by the failing circulation, which provides a rational in using the drug in congestive heart failure (CHF) with sinus rhythm. The use of this drug is a standard therapy in the treatment of CHF with atrial fibrillation. However, the dose adjustment of this drug is difficult because of the variation in its pharmacokinetic characteristics, the variability in its clearance, and the lack of a good relationship between the dose and the desired effect and its narrow therapeutic range. This creates difficulty for clinicians to choose the appropriate dosage of the drug to get the desired benefit without the risk of toxicity. In many countries, serum concentration monitoring is not always possible, so it is common in clinical practice to drop the medication for 1 or 2 days a week, giving the drug a ‘holiday,’ to avoid the risk of toxicity. This is contrary to the use of this drug without interruption in countries where routine serum concentration monitoring is possible. This review provides a summary of the evidence relating to the rationale behind using digoxin holiday and the therapeutic implications of digoxin holiday. Much of the information is available from prospective crossover clinical trials. There are no randomised control trials of digoxin holiday in patients with heart failure and/or atrial fibrillation.
地高辛的节日
地高辛在临床实践中有两个主要目的:改善心力衰竭患者的心室功能,降低射血分数,控制心房颤动患者的心室率。它是一种心脏糖苷,具有正性肌力作用,通过迷走神经效应引起房室结抑制。它还能降低循环衰竭产生的交感神经驱动,为充血性心力衰竭(CHF)伴窦性心律提供了合理的用药依据。使用该药是治疗CHF合并心房颤动的标准疗法。然而,由于其药代动力学特性的变化、清除率的变异性、剂量与预期效果的关系不佳、治疗范围窄等原因,该药的剂量调整较为困难。这给临床医生选择合适的药物剂量以获得预期的益处而又没有毒性风险带来了困难。在许多国家,血清浓度监测并不总是可能的,因此在临床实践中,通常每周停药1或2天,给药物一个“假期”,以避免毒性风险。这与在可以进行常规血清浓度监测的国家不间断使用该药物相反。本文综述了地高辛假期使用的基本原理以及地高辛假期的治疗意义。大部分信息可从前瞻性交叉临床试验中获得。尚无地高辛假期在心力衰竭和/或房颤患者中的随机对照试验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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