Originally published on weChat public account: Cardiovascular Time, author: Cai Yanhui. If there is infringement, contact to delete.
Digitalis drugs can improve symptoms in patients with heart failure, reduce the risk of hospitalization in patients with chronic HFrEF, can be used to control the ventricular rate in patients with atrial fibrillation, and can be preferred for intravenous digitalis to control the ventricular rate when acute heart failure is combined with rapid atrial fibrillation, and the current applications are more high-scoring and deacetyl pithrin.
1. Digoxin injection
1) Guidelines recommended
- Recommended in the 2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure
(1) Patients with symptomatic sinus rhythm HFrEF who have received ACE/ARB, β blockers, and aldosterone receptor antagonists may be considered to use digoxin to reduce the risk of hospitalization for all-cause or heart failure;
(2) In patients with atrial fibrillation complicated with heart failure (NYHA cardiac function iv. grade) with rapid ventricular rate, intravenous digitalis drugs may be considered to control ventricular rate;
(3) For patients with atrial fibrillation complicated with heart failure (NYHA cardiac function grades I to III.), if the use of β blockers is ineffective, intolerable, or contraindicated, digoxin can be considered to control ventricular rate.
- Recommended in the Chinese Guidelines for the Diagnosis and Treatment of Heart Failure 2018
(1) Patients with acute heart failure with atrial fibrillation with rapid ventricular rate (> 110 beats/min) can use digitalis drugs intravenously;
(2) Patients with HFrEF who are intolerant, contraindicated, and poorly responded to β receptor blockers, and HFrEF patients with NYHA cardiac function grade I.-III. and atrial fibrillation can control ventricular rates with digoxin;
(3) Patients with grade IV heart failure with NYHA cardiac function with atrial fibrillation may be considered with intravenous digitalis to control ventricular rate.
Tips:
The ARISTOTLE study, which evaluated apixaban in patients with atrial fibrillation, showed that initiation of digoxin therapy was independently associated with mortality in patients with atrial fibrillation, with a concentration of ≥ 1.2 micrograms/L at the highest risk of death.
Therefore, European guidelines downgrade digitalis to Class II.b recommended that patients with sinus rhythm HFrEF who still have symptoms after standardized drug therapy may be considered.
However, the Chinese guidelines, taking into account the current status of digoxin use and the increased mortality rate of digoxin, did not come from randomized controlled studies, maintaining the category II.a recommendation for digoxin, emphasizing the use of small doses and monitoring of digoxin blood concentrations at 0.5 to 0.9 micrograms/L.
2) Precautions
(1) Digoxin injection should not be compatible with acids and alkalis. Contraindications with calcium injections are contraindicated.
(2) Adverse reactions often occur at digoxin blood concentrations of > 2.0 μg/L, but poisoning can occur even when low serum concentrations are low at low potassium, low magnesium, myocardial ischemia, and hypothyroidism.
(3) When combined with drugs that can inhibit the function of the sinus node or avioventricular node (such as amiodarone, β receptor blockers), the heart rate must be closely monitored;
When quinidine, verapamil, amiodarone, propafenone, clarithromycin, itraconazole, cyclosporine, erythromycin, etc. are combined with digoxin, which can increase the blood concentration of digoxin and increase the risk of drug poisoning.
2. The difference with deacetyl mucoidin injection
1) Pharmacokinetic indicators
Deacetyl mucoidin loses glucose and acetic acid in the body and is converted into digoxin, so compared with digoxin injection, it does not have direct activity, needs to be metabolized, and the onset time is slightly slower.
Digoxin injection is recommended for patients with hepatic dysfunction.
2) Dosage
