ArticleEuropean journal of clinical pharmacology2026
Critical analysis of digitalis glycosides: declining use but increasing poison-center exposure cases for digitoxin.
Article in European journal of clinical pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
PURPOSE &
backgroundBelonging to one of the oldest drug classes in cardiovascular-medicine, the scientific interest in Na
methodsBy using prescription data (defined daily dose, DDD) and poison center records between 1990 and 2023 in Germany we conducted a pharmacological, pharmacoeconomic and toxicological analysis of the four NKA-inhibitors digitoxin, digoxin, acetyldigoxin and metildigoxin. For identifying trend changes and prescribing trends, we used joinpoint regression and DDD-half-time analyses.
resultsThe DDD of NKA-inhibitors declined substantially over our investigated timeframe. Reported exposure cases involving digitoxin, recorded by the GIZ-Nord poison center, showed a significant and continuous increase. Population-adjusted exposure cases increased by 4.65% per year. Exposure-adjusted exposure cases per 1 mio. DDD increased by 11.80% per year. The data for reported cases involving digoxin showed large year-to-year variability and no significant increase in reported case numbers. The PRISM DDD-half-time analysis showed big differences between the four substances, with digitoxin exhibiting the longest DDD-half-time despite the absence of supportive evidence in the form of clinical trials, suggesting a dissociation between evidence and real-world prescriptions.
conclusionsPrescription volumes decrease but digitoxin is associated with steadily increasing reports of exposure cases from poison center data. This indicates discrepancies between prescribing trends and real-world exposure patterns and highlights the importance for patient selection and careful monitoring, especially in elderly patients.
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