Digoxin (Lanoxin, Digitek) is approved by the FDA for the treatment of mild to moderate heart failure. It is often used in combination with a thiazide diuretic or water pill, and an angiotensin converting enzyme (ACE) inhibitor. Digoxin (Lanoxin) is also approved to control the rate of beating of the large chambers of the heart (ventricles) in people with a chronic rapid beating of the small chambers of the heart (atria).
The symptoms of heart failure are fatigue, difficulty breathing, swelling (especially in the legs and ankles), and rapid or “galloping” heartbeats.
Before prescribing Digoxin for heart failure, your doctor should first try giving you another type of drug called a thiazide diuretic (water pill). You should only switch to Digoxin if the diuretic does not control your symptoms well enough. In general, if you are over 60, you should be taking a smaller daily dose than the usual 0.25 milligrams, especially if you have impaired kidney function.
Anyone taking Digoxin is at risk of toxic effects (digitalis toxicity). While you are taking Digoxin, your doctor 
should regularly check the levels of the drug in your blood. You and your doctor should also watch for the subtle symptoms of toxicity: fatigue, loss of appetite, nausea and vomiting, problems with vision, bad dreams, nervousness, drowsiness, and hallucinations. Other signs of toxicity are changes in heart rhythm, slow pulse, and lethargy. Since there is a narrow range between a helpful and a harmful amount of Digoxin in your body, you should take the drug daily in the exact amount prescribed. If you get too much Digoxin in your body, you may develop the effects listed above; if you get too little, you may develop symptoms of heart failure or a rapid heart rate.
The abrupt onset of dementia has been associated with Digoxin use. The dementia is reversible when Digoxin use is stopped.
Digoxin is often overprescribed for older adults. One study of people using Digoxin outside the hospital found that four out of ten were getting no benefit from the drug. Because of Digoxin’s toxic effects, taking the drug when it has no benefit is both wasteful and dangerous. As many as one in five Digoxin users develop signs of toxic effects, and much of this could be prevented if the people who did not need Digoxin were taken off the drug. Evidence shows that up to eight out of ten long-term Digoxin users can stop using the drug successfully, under close supervision by a doctor, with no harmful results. This is partly due to Digoxin being wrongly prescribed in the first place.
If you have used Digoxin regularly for some time, ask your doctor if you might be able to try withdrawing from the drug. You are more likely to be able to stop taking Digoxin if you meet the following conditions:
- You have used Digoxin for a long time without your initial symptoms of heart failure coming back.
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You have a normal heart rhythm.
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You are not using Digoxin to control an irregular heart rhythm.
There is no good way of knowing in advance who can stop taking Digoxin. People taking Digoxin to correct an irregular heart rhythm should not attempt to stop taking the drug, but most other people will benefit from a trial of withdrawal under close supervision by a doctor.
