Digoxin: Indications & Contraindications

Instructor: Adrianne Baron

Adrianne has a master's degree in cancer biology and has taught high school and college biology.

This lesson is going to look at what digoxin is and what it is useful for treating. We will look at the drug and health contraindications that affect the ability to receive digoxin treatment.

Digoxin

Think about your morning and evening commute to and from work for a minute. If you are lucky, it runs smoothly day and night with little to no traffic. That would only happen if every vehicle on the highway is moving at the same speed at equal distances. There also couldn't be any car crashes. For most people working in most major cities, this hardly if ever happens. Your commute is probably more so riddled with accidents, stalled cars, and overall traffic. The next thing you know, the entire interstate system through the heart of your city is a huge mess!

The same can happen if cells, proteins, and other substances don't move the way they are supposed to through our bodies. It is the responsibility of our hearts to make sure that blood continues to move and at just the right speed with just the right amount of blood being pushed through with each pump. In the event that the heart isn't functioning optimally, then there are drugs that can be taken to help get the heart and blood vessels, which are the body's transportation system like a highway, working right again.

Digoxin treats cardiac arrhythmias
Bottle of digoxin

One such drug that is able to help the heart function the way that it is supposed to is digoxin. This is what is known as an antiarrhythmic drug that works by altering the sodium-potassium pump in the heart thereby affecting contractions of the heart.

Indications

So we know that digoxin can help the heart to contract properly, but there are numerous ways for the heart to work improperly. It could beat too fast, too slow, not hard enough, too hard, not beat in sequence, the upper chambers could beat faster than the lower or vice versa. There is a lot that can go wrong. So which heart problems can digoxin help with?

Based on the classification as an antiarrhythmic drug, you may have already realized that it is used to treat cardiac arrhythmias. This is any abnormal beating of the heart. The primary arrhythmia treated with digoxin is atrial fibrillation. This is a condition of the heart when the upper chambers quiver or partially instead of fully contract.

Digoxin also has the ability to affect the amount of fluids in the body and so it is very useful in treating heart failure, which is when the heart doesn't function well enough to meet the demands of the body. When this happens, fluid builds up in the body and can begin to surround the heart which further prevents it from functioning well. Digoxin helps from both angles of heart function and reducing fluid.

Contraindications

Drug Contraindications

You know how the saying goes, 'Everything isn't for everybody'. You could change it to say that, 'Everything isn't for every body'. Get the difference? While digoxin works wonders to correct cardiac problems in one person, it can be harmful for the next depending on other health conditions and drugs taken.

If you are taking any of a wide variety of drugs for heart problems, antibiotics, HIV drugs, or NSAIDS, then these can prevent you from getting the full benefit of taking digoxin. These categories of drugs cause an increase in the amount of digoxin in your system and that can have harmful, adverse effects on your heart and body.

Being on atorvastatin, cyclosporine, nilotinib, itraconazole, nefazodone, tolvaptan, quinine, and ranolazine will also increase the amount of digoxin in the bloodstream and may cause your heart rate to become too slow or blood pressure to drop too low.

Digoxin is also contraindicated if you are taking stimulant drugs, such as epinephrine or norepinephrine, or succinylcholine. Combining these drugs in your body can cause you to have an irregular heartbeat. That, of course, would defeat the whole reason why you are taking digoxin to begin with.

Heart Condition Contraindications

You may have already surmised that certain heart conditions would keep you from taking digoxin. Having myocarditis, infection in the heart muscle, previous heart attack, and ventricular fibrillation, quivering or shaking of the lower chambers of the heart, would prevent a person from being able to take digoxin. Digoxin has the potential to make these conditions more severe, which can lead to heart attack or cardiac arrest.

Digoxin is also not indicated for people that have Wolff-Parkinson-White as this can increase the already existent risk of an abnormal heart rhythm. This could also result in heart failure.

Other Health Contraindications

We have already established that digoxin works by altering the sodium-potassium pump. These are electrolytes whose concentrations and locations are changed by digoxin. If you have an electrolyte imbalance, then digoxin is not for you. It can cause a more severe electrolyte imbalance that can lead to muscle contraction failure, kidney failure, and cardiac arrest.

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