Department of Pharmacy Practice, Vikas Institute of Pharmaceutical Sciences, Nidigatla Road, Rajahmundry, Andhra Pradesh-533289, India

Department of Pharmacy Practice, Vikas Institute of Pharmaceutical Sciences, Nidigatla Road, Rajahmundry, Andhra Pradesh-533289, India

Department of pharmacy practice, Seven Hills College of Pharmacy, Venkatramapuram, Tanapalli, Tirupati, Andhra Pradesh-517561, India.

Department of pharmacy practice, Basaveswara medical college, Hospital & Research Centre, Chitradurga, Karnataka-577502, India.
Clopidogrel ,Losartan ,Acenocoumaral ,

Digoxin is the cardiac glycoside,it is having cardiac inotropic property. This biological sourceis obtained from digitalis lanata. Digoxin Mechanism of action is increase the force of cardiac contraction by a direct action. Gynecomastia is one of the extra cardiac side-effect of digoxin but it is rare. The structural similarity of the digitalis glycosides areaglycones to the cyclopentano-perhydrophenanthrene radical of the steroidal hormones, so chances of getting gynecomastia is possible due to digoxin. Approximately 10% - 25% cases of gynecomastia are due to drugs2. Mechanisms by such drugs cause gynecomastia including inhibition of androgen synthesis and/or metabolism (ketoconazole), antagonism at androgen receptor (flutamide, finastride), direct action at oestrogen receptors by oestrogen-like drugs (oestrogen vaginal cream, clomiphine) and displacement of oestrogen from sex hormone-binding globulin (thereby increasing the free oestrogen level, e.g. spironolactone)3. Some drugs can directly damage the testis and may cause gynecomastia (busulfan, vincristine). Anorexia, abdominal pain, vomiting are the common extra cardiac side effects of digoxin.but those are common.Gynecomastia is occasional or rare with digoxin, there isanevidence digoxin may cause gynecomastia because of oestrogen-like steroid moiety of the digoxin molecule1.Gynecomastia that occurs outside of these peaks of prevalence may be a pathologic sign of an underlying process, thereby necessitating further work-up. Breast symptoms can include a symmetric or asymmetric increase in size (occasionally unilateral), the development of nipple and/or breast tenderness, and/or the appearance of discrete breast masses.

5 , 3 , 2015