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Titolo:
Treatment of congestive heart failure - current status of use of digitoxin
Autore:
Belz, GG; Breithaupt-Grogler, K; Osowski, U;
Indirizzi:
ZeKaPha GmbH, Ctr Cardiovasc Pharmacol, D-55116 Mainz, Germany ZeKaPha GmbH Mainz Germany D-55116 asc Pharmacol, D-55116 Mainz, Germany Merck KGaA, Clin Pharmacol, Darmstadt, Germany Merck KGaA Darmstadt Germany k KGaA, Clin Pharmacol, Darmstadt, Germany
Titolo Testata:
EUROPEAN JOURNAL OF CLINICAL INVESTIGATION
, volume: 31, anno: 2001, supplemento:, 2
pagine: 10 - 17
SICI:
0014-2972(2001)31:<10:TOCHF->2.0.ZU;2-3
Fonte:
ISI
Lingua:
ENG
Soggetto:
IMPAIRED RENAL-FUNCTION; DIGOXIN-SPECIFIC FAB; SINUS RHYTHM; DIGITALIS INTOXICATION; MAINTENANCE DIGOXIN; CONTROLLED TRIAL; PROTEIN BINDING; ORAL MILRINONE; PLACEBO; WITHDRAWAL;
Keywords:
digitoxin; digoxin; congestive heart failure; mortality; morbidity; systolic tachycardia;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
72
Recensione:
Indirizzi per estratti:
Indirizzo: Belz, GG ZeKaPha GmbH, Ctr Cardiovasc Pharmacol, Mathildenstr 8, D-55116 Mainz, Germany ZeKaPha GmbH Mathildenstr 8 Mainz Germany D-55116 Mainz, Germany
Citazione:
G.G. Belz et al., "Treatment of congestive heart failure - current status of use of digitoxin", EUR J CL IN, 31, 2001, pp. 10-17

Abstract

Digitalis glycosides exert a positive inotropic effect, i.e. an increase in myocardial contractility associated with a prolongation of relaxation period, and glycosides lower the heart rate (negative chronotropic), impede stimulus conduction (negative dromotropic) and promote myocardial excitability (positive bathmotropic). They seem to influence the activities of both the vagal and the sympathetic systems. Digitalis glycosides that belong to different substance classes are closely comparable concerning pharmacodynamics bur differ substantially in regard to pharmacokinetics. Digoxin and its derivatives are less lipophilic, show lower protein binding and shorter half-life, are mainly eliminated via the kidney and accumulate rather rapidly in cases of insufficient kidney function. Digitoxin is highly lipophilic andextensively bound to plasma proteins, has a longer half-life, is mainly eliminated in the metabolized state via urine and faeces and does not accumulate in kidney dysfunction. As a result of a more stable pharmacokinetic profile, the incidence of toxic side effects seems to be lower with digitoxin than with digoxin. Since the beginning of the 1990s, the antagonists of theRAAS qualified as the standard treatment for congestive heart failure, often in combination with diuretics, vasodilators or beta -antagonists. However, the important role of digitalis glycosides as therapeutic comedication or alternative was never denied, especially in atrial fibrillation with tachycardia. The PROVED and RADIANCE trials proved a detrimental effect of the withdrawal of digoxin therapy on exercise capacity, left-ventricular ejection fraction and clinical symptoms. The DIG trial revealed that digoxin comedication in sinus rhythm patients with congestive heart failure was associated with a lower morbidity las taken from death or hospitalization because of worsening heart failure) and an unchanged overall mortality - being a unique feature among the available inotropic drugs. Comparable studies for digitoxin have not yet been performed but, because of its higher pharmacological stability, it might well be associated with even more advantages in this regard than digoxin.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 11/07/20 alle ore 17:03:20