Letter to the Editor

Evidence-Based Medicine and Digoxin

Authors: James M. Wooten, PharmD


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Above, Dr Turagam discusses the relevant issue of what should be done when older treatment modalities become “outdated.”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.

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1. Lip GY, Beevers DG. ABC of atrial fibrillation. History, epidemiology, and importance of atrial fibrillation. BMJ. 1995; 311: 1361–1363.
2. Wooten JM. Comparing new anticoagulants. South Med J. 2012; 105: 665–669.
3. Freeman JV, Reynolds K, Fang M, et al. Digoxin and risk of death in adults with atrial fibrillation: the ATRIA-CVRN Study. J Am Coll Cardiol. 2013; 61: E262
4. Veldhuisen Dj, Van Gelder IC, Ahmed A, et al. Digoxin for patients with atrial fibrillation and heart failure: paradise lost or not? Eur Heart J. 2013 Jan 16;.[Epub ahead of print]