Comparison of heart rate and symptoms in two different methods of digoxin prescription

Background: Medication interruption of two days a week is common in Iran to avoid the toxic effects of digoxin; however, the efficacy on symptoms and heart rate is not well studied yet. Methods: The current clinical trial was conducted on patients receiving a digoxin regimen of 0.125mg/day or 0.25 mg/day except for Mondays and Fridays (0.25mg/day-5/7) for atrial fibrillation (AF) or heart failure (HF). After measuring digoxin level and heart rate and scoring the clinical symptoms, the enrolled patients were switched to another method of digoxin prescription. The symptoms were reevaluated after four weeks of changing the regimen of digoxin. The study was registered in the Iranian Registry of Clinical Trials (IRCT) (No. 20110512006463N2). Results: A total of 77 patients completed the study. The mean age of the enrolled group was 65.16±11.64 years, and 44 patients (55.7%) were female. The mean digoxin level was 0.76±0.35 in the 0.125mg/day regimen, which changed to 0.94±0.56 in the 0.25mg/day- 5/7 regimen (P=0.034). Heart rate (HR) and daily activity scores, pain, spiritual feelings, energy, dyspnea, palpitation, nausea, blurred vision, and quality of life did not show any significant changes in the two regimens. The results of subgroup analysis in patients with AF were similar in terms of HR and symptoms, while in the subjects without AF, the scores of daily activity, dyspnea, palpitation, and quality of life significantly improved with the 0.25mg/day-5/7 regimen. Conclusions: Results of the current study showed that the HR and symptoms were not considerably different in the two regimens, whereas the digoxin level was significantly higher in the 0.25mg/day-5/7 regimen. Furthermore, in the subgroup with HF but without AF, the 0.25mg/day-5/7 regimen offered a better symptom control of dyspnea, palpitation, daily activity, and quality of life.