Use of Lanoxin (Digoxin) in Acute Decompensated Heart Failure

Primary Indications in Acute Decompensated Heart Failure

The American Heart Association recommends digoxin for rate control in patients with rapid atrial fibrillation, particularly when initiating beta-blockers is not immediately feasible 1, 2
Digoxin is useful for initial control of ventricular rate in patients with rapid atrial fibrillation and may be considered in decompensated heart failure patients prior to initiation of a beta-blocker, as suggested by the European Society of Cardiology 3, 4
The European Society of Cardiology recommends a rate control target with digoxin, which is most beneficial when ventricular rate at rest is >80 bpm or during exercise >110-120 bpm 5, 6

The American College of Cardiology states that digoxin is not indicated as primary therapy for the stabilization of patients with an acute exacerbation of heart failure symptoms, including fluid retention or hypotension 1, 2
Such patients should first receive appropriate treatment for heart failure, and therapy with digoxin may be initiated after stabilization as part of a long-term treatment strategy, according to the American Heart Association 2, 7

The European Society of Cardiology recommends that in patients with reduced ejection fraction and atrial fibrillation, digoxin should be used to control heart rate in addition to, or prior to, a beta-blocker 5, 3
Digoxin should be used in symptomatic patients with NYHA functional class II-IV symptoms, as suggested by the European Society of Cardiology 3, 6
Optimal background therapy with digoxin should be used after or in addition to diuretics and ACE inhibitors/ARBs, according to the American College of Cardiology 1, 2

The European Society of Cardiology states that digoxin is contraindicated in patients with second- or third-degree heart block (without a permanent pacemaker) 3, 2
Digoxin is also contraindicated in patients with suspected sick sinus syndrome, pre-excitation syndromes, or previous evidence of digoxin intolerance, as recommended by the European Society of Cardiology 3

The European Society of Cardiology recommends a starting dose of 0.25 mg daily for adults with normal renal function, and reduced dosing for the elderly and those with renal impairment 3, 2
Loading doses are generally not required in stable patients with sinus rhythm, but may be considered in acute settings, according to the European Society of Cardiology 3, 2

The European Society of Cardiology recommends serial monitoring of serum electrolytes and renal function due to the risk of atrial and ventricular arrhythmias, particularly with hypokalaemia 5, 3
Digoxin should be used cautiously in patients taking other drugs that can depress sinus or atrioventricular nodal function or affect digoxin levels, as suggested by the American College of Cardiology 2, 7

The European Society of Cardiology recommends that in the longer term, a beta-blocker, either alone or in combination with digoxin, is the preferred treatment for rate control in patients with LVEF < 40% 5, 3
Digoxin may be considered in decompensated heart failure patients prior to initiation of a beta-blocker, according to the European Society of Cardiology 3, 6

The European Society of Cardiology states that digoxin reduces hospital admission for worsening heart failure but has no effect on survival 3, 6