Abstract

To the Editor:

Above, Dr Turagam discusses the relevant issue of what should be done when older treatment modalities become “outdated.” The letter examines the use of digoxin as an antiarrhythmic drug to slow the ventricular rate in patients with atrial fibrillation (AF). The author notes that only in rare situations should digoxin be used for this purpose because the clinical evidence to validate its safety or efficacy in most situations is not available. Since 1775, when English physician Sir William Withering recounted the virtues of Digitalis purpurea (foxglove plant), medical professionals have attempted to detail the precise pharmacological attributes of the drug.¹ Even though cardiac glycosides have been researched extensively, the precise pharmacological action of this drug class remains a mystery as does its safety profile. It is this unpredictability that makes digoxin a dangerous drug, although it has been used for a long time by physicians around the world.