Krytyczna analiza glikozydów naparstnicy: malejące stosowanie, ale rosnąca liczba przypadków ekspozycji zgłaszanych do ośrodków toksykologicznych dla digitoksyny

PURPOSE & BACKGROUND: Belonging to one of the oldest drug classes in cardiovascular-medicine, the scientific interest in Na+/K+-ATPase inhibitors (NKA-inhibitors, digitalis glycosides) has increased once again after the publication of the recent DIGIT-HF study. This analysis and scoping review aim to assess long-term prescribing trends of NKA-inhibitors and poison center data to investigate the discrepancy between declining use and increasing poison center reports involving digitoxin in Germany. METHODS: By 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. RESULTS: The 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. CONCLUSIONS: Prescription 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.