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Digoxin, a cardiac glycoside, is commonly prescribed for the management of congestive heart failure, atrial fibrillation or flutter, and certain cardiac arrhythmias. However, its clinical use is limited by its narrow therapeutic index, which predisposes patients to toxicity. At elevated concentrations, digoxin toxicity can present with gastrointestinal disturbances, visual changes, and cardiac arrhythmias. This systematic review aims to summarize reported cases of digoxin toxicity, focusing on associated risk factors, drug-drug interactions, and clinical manifestations. A comprehensive literature search was conducted using PubMed and Ovid MEDLINE with the keywords “digoxin” and “toxicity.” Clinical and laboratory features of toxicity were extracted and analyzed. Of the 2,399 articles identified, only 10 met the inclusion criteria for final review. In 4 of the 10 cases, diuretics were implicated as interacting medications. Commonly reported symptoms included nausea, vomiting, visual disturbances, bradycardia, and elevated serum digoxin levels. Identified risk factors for toxicity included female sex, advanced age (60–91 years), renal impairment, and concomitant drug use. Notably, toxicity was observed even at therapeutic or low serum digoxin concentrations in the presence of these risk factors. The most frequent clinical manifestations were gastrointestinal symptoms, vision changes, and bradycardia.

Creatine is a naturally occurring compound found in muscle tissue that plays a vital role in cellular energy metabolism. While traditionally recognized for its benefits in enhancing skeletal muscle function and exercise performance, recent research has highlighted its potential therapeutic applications in various medical fields. This study reviews the available literature to assess the current state of knowledge regarding creatine’s medical uses and outlines directions for future research. Evidence has demonstrated a correlation between low creatine levels and reduced mental well-being, suggesting a role in the central nervous system. Notably, creatine has been explored as a potential antidepressant—both as a standalone treatment and as an adjunct to selective serotonin reuptake inhibitors (SSRIs)—owing to its newly discovered function as a neurotransmitter. Additionally, long-term investigations into creatine’s molecular mechanisms in the brain have prompted its study in stroke management, where it may support both prevention in high-risk populations and post-stroke rehabilitation. In the context of chronic heart failure, creatine has been linked to cardiomyocyte metabolic dysfunction, particularly regarding disruption of the creatine/phosphocreatine/ATP shuttle. Although studies examining creatine supplementation in cardiovascular disease have produced mixed results, the compound shows promise as a supportive therapy. However, further research is necessary to confirm its efficacy and safety across these medical applications.