Benefit versus toxicity risk of digoxin in patients with COVID-19

Abstract

As the oldest cardiac glycoside with a narrow therapeutic index and complex pharmacokinetic profile, digoxin is still used to treat many conditions such as congestive heart failure (CHF), atrial fibrillation or flutter, and certain cardiac arrhythmias.1 Its distribution in the heart and muscles might increase due to hyperthyroidism or hypokalaemia and decrease due to hyperkalaemia or hyponatraemia.1 Digoxin is the minor substrate of cytochrome-P450 (CYP) 3A4 and the major substrate of P-glycoprotein/ABCB1.1