Abstract
Digoxin is one of the oldest cardiac medicines still used in current practice. Over the years its place in the treatment of arrhythmias has changed following the advent of other anti-arrhythmic medications which have comparable effectiveness and tolerability. Digoxin inhibits the Na+-K+ pump and Ca2+ currents in the atrioventricular node and has a relatively slow onset of action when compared with other anti-arrhythmics such as β-blockers and calcium channel blockers. Its narrow therapeutic window requires serum levels to be taken for reasons such as the exclusion of toxicity. Digoxin is indicated for ventricular rate control in fast atrial fibrillation (AF) but it is ineffective in in cardioverting patients. It is not indicated for paroxysmal AF, where it may, in fact, worsen the condition. Digoxin is proven to benefit patients with heart failure and it should not be withdrawn from patients whose condition has previously been stabilized on digoxin.
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