Elsevier

American Heart Journal

Volume 93, Issue 4, April 1977, Pages 434-443
American Heart Journal

Studies on digitalis: XIII. A prospective study of 649 patients on maintenance treatment with digitoxin

https://doi.org/10.1016/S0002-8703(77)80405-5Get rights and content

Summary

In a prospective study of digitalis intoxication in 649 patients on maintenance treatment with digitoxin a low incidence of digitalis toxicity was found, namely, 5.8 per cent. This is mainly due to a more careful use of digitalis glycosides. It is especially important to reduce the dose of digitoxin in elderly and thin individuals. Digitoxin is metabolized in the liver and partly excreted through the kidneys as metabolites. Serum half-time of digitoxin is shortened in patients with impaired renal function. Patients with reduced renal function may be treated with digitoxin in the same doses as individuals with normal renal function. This is in contrast to patients treated with digoxin. Digitoxin should therefore be the cardiac glycoside of choice in treatment of patients with renal failure. Digitoxin is further rapidly eliminated in patients with reduced liver function in spite of its extensive hepatic metabolism.

In this study extracardiac symptoms were found equally often as cardiac signs of toxicity. Patients intoxicated usually had several symptoms and signs of toxicity at the same time. The specificity of commonly used symptoms and signs of digitalis intoxication is very low. In this study atrial tachycardia with block, which has been considered to be an important cardiotoxic arrhythmia, very seldom was found in digitalis intoxication.

There is an overlap in digitalis serum concentration between toxic and nontoxic patients. The diagnosis of toxicity was made on clinical ground. Most of the intoxicated patients had high serum concentrations, but some had concentrations in the normal or low range. Apart from being a guide to the diagnosis of digitalis intoxication, serum digitalis levels may further be a guide to underdigitalization of cardiac patients, especially patients in sinus rhythm.

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    1

    From University Hospitals, Rikshospitalet, Medical Department B, Oslo; Ullevl Hospital, Medical Department VIII, Oslo; Akershus Central Hospital, Medical Department, Oslo, Norway.

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