Clinical Utility of Serum Digoxin Level in Cardiac Patients for Diagnosis of Chronic Digitalis Toxicity (original) (raw)

Serum digoxin levels and mortality in 5,100 patients

Annals of Emergency Medicine, 1987

A retrospective study of 5,I00 patients on digoxin, with a four-week follow up after digoxin levels were measured, was done to determine the mortality rate. A significant increase in mortality was correlated with an increasing serum digoxin level, up to 50% at a level of 6.0 ng/mL and more. Clinical toxicity was suspected in only 0.25% of all patients on digoxin, although almost 10% had levels above the therapeutic range. Deliberate digoxin overdoses were fatal in 50% of cases. This study shows a correlation between increasing digoxin levels and increasing mortality rates. We recommend the use of serum digoxin measurements to identify those asymptomatic patients with elevated levels. The physician should seriously consider the indications for initiating or continuing digoxin treatment in any patient because of an increased mortality in patients with levels of more than 1.0 ng/mL.

Digoxin Toxicity Compared with Myocardial Digoxin and Potassium Concentration

British Journal of Pharmacology, 1978

Twenty-nine dogs were given digoxin (0.25 mg) by mouth twice daily for eight days. Some of them (group 1) also received diuretics and others (group 2) a mineralocorticoid. The dogs were then given an intravenous bolus injection of digoxin and plasma and cardiac muscle were analysed for digoxin and potassium. 2 In the digitalized dogs, myocardial potassium concentration decreased following the intravenous injection of either 0.05 or 0.15 mg/kg digoxin; in contrast, in those dogs given diuretics or mineralocorticoid the potassium concentration increased. 3 Ventricular arrhythmias occurred after digoxin injection (0.05 mg/kg) in the hypokalemic dogs, in those given a mineralocortocoid and in those dogs which received a toxic digoxin dose (0.15 mg/kg). No arrhythmias where seen in the control (digitalized) group. 4 Myocardial digoxin concentrations were similar in the control digitalized group and in the mineralocorticoid-treated dogs after the intravenous administration of the lower digoxin dose (0.05 mg/kg). The myocardial digoxin concentration was significantly higher in the hypokalemic group and in the group receiving the higher digoxin dose (0.15 mg/kg). 5 There was no obvious relationship between the occurrence of arrhythmias and the myocardial concentration of digoxin or potassium.

ABC of monitoring drug therapy. Digoxin

British Medical Journal, 1992

The plasma digoxin concentration that will result from a given dose of the drug can be predicted at best with only 34% accuracy, although knowledge of a previous concentration improves the ability to predict subsequent concentrations. In outpatients taking a fixed daily dosage, a steady state plasma digoxin concentrations vary widely (between 0 5 and 3 5 nmol/l). This means that if a target plasma digoxin concentration is desirable measuring the concentration may be useful in tailoring dosages to individual requirements.

Therapeutic drug monitoring of digoxin–20 years of experience

Pharmacological Reports, 2017

Background: Digoxin is the oldest drug used in the pharmacotherapy of heart failure (HF). However, digoxin remains an important therapeutic option for patients with persistent symptoms of HF occurring despite the implementation of standard pharmacotherapy. Digoxin concentration serum (SCD) should equal 1-2 ng/ml. The aim of our study was to measure of SCD among the hospitalized patients as well as to determine the selected factors influencing the concentration of the digoxin in the blood. Methods: The presented research was based on a retrospective analysis including 2149 patients treated with digoxin and hospitalized between 1980 and 2000. Was used for the determination of SCD automatic analyzer TDX ABBOTT GmbH-fluorescence polarization immunoassay (FPIA), with therapeutic range for digoxin of 0.8-2.0 ng/ml. Results: Average SCD result in the study population was located within the therapeutic range and amounted 1.06 ng/ml (55.7 % of patients). Statistically significant differences in digoxin level were observed depending on the way of medicine administration (p=0.000001) and the daily amount (p=0.001). Moreover, statistically significant differences in digoxin level were observed depending on sex (p=0.00002). Conclusions: An elevated level of digoxin was observed in the case of patients who received the medication both orally and intravenously, together with an increase in the daily amount of digoxin doses. It was confirmed that an elevated digoxin level occurs in the course of treatment in the case of women.

Digoxin intoxication: An old enemy in modern era

Journal of geriatric cardiology : JGC, 2012

Objectives Although development of new treatment modalities limited digoxin usage, digoxin intoxication is still an important issue which could be easily overlooked. In this report, we analyzed a case series definitively diagnosed as digoxin intoxication in the modern era. Methods We analyzed 71 patients hospitalized with digoxin intoxication confirmed by history, complaints, clinical and electrocardiograph (ECG) findings, and serum digoxin levels > 2.0 ng/mL, during a five year period. The demographic and clinical data, indications for digoxin use, digoxin dosage, concurrent medications, laboratory data, hospital monitoring, and ECG findings were obtained from all patients. Results Thirty-eight of 71 patients (53.5%) had symptoms of heart failure during admission or later. Sixty-four percent of patients were older than 75 years. The percentage of females was 67%. Atrial fibrillation, hypertension and gastrointestinal complaints were more frequent in the females (64% in females, 30% in males, P = 0.007; 81% in female, 52% in males, P = 0.01; 50% in female, 17.3% in males, P = 0.008, respectively). The mortality rate during the hospital course was 7%. Conclusions This report demonstrated the reduced mortality rates in patients with digoxin intoxication over the study period. Gastrointestinal complaints are the most common symptoms in this population.

A Retrospective Analysis about the Quality of Therapeutic Drug Monitoring of Digoxin

2015

Since therapeutic range of digoxin is extremely narrow, many patients have been admitted to emergency department due to digoxin intoxication. Therefore, the level of blood digoxin should be followed at frequent intervals in patients who are taking digoxin treatment. In this study, we aimed to evaluate inappropriateness or erroneous practices and to identify their reasons in therapeutic drug monitoring (TDM) of digoxin usage, retrospectively. In this study, we analyzed the results of serum digoxin levels of 1186 inpatients and outpatients from Laboratory Information System (LIS) from January 2013 to July 2015. Results of serum digoxin levels varied from 0.0 nmol/L to 6.9 nmol/L. 47.9% of digoxin levels were in subtherapeutic range, 45.4% of were in therapeutic range, and 6.7% of were in toxic range. Serum digoxin levels were higher in females and in 70-79 ages of patients. TDM of digoxin is useful for enhancing the therapeutic benefits of digoxin and minimizing the incidence of adver...

Digoxin Use and Digoxin Toxicity in the Post-DIG Trial Era

Journal of Cardiac Failure, 2006

Background: The advent of medical therapies for congestive heart failure that have proven survival benefits, specifically angiotensin-converting enzyme (ACE) inhibitors, b-adrenergic antagonists, and the aldosterone antagonists, have called into question the use of digoxin for patients with normal sinus rhythm, left ventricular dysfunction, and symptomatic heart failure. This issue appears to have been heightened after the publication of the results of the Digitalis Investigation Group (DIG) Trial in 1997 that did not demonstrate a statistically significant impact of digoxin on mortality. Methods and Results: We used data from a large heart failure registry to examine digoxin use at the time of hospital admission for heart failure, a surveillance system for recording toxic drug exposures to describe patterns in digoxin toxicity and industry estimates for the use of digoxin antibody. Digoxin use has decreased significantly from 31.4% in late 2001 to 23.5% in late 2004 (P ! .00001) independent of patient age, gender, or baseline creatinine. Conversely, the number of toxic or potentially toxic exposures to digoxin requiring hospitalization has not decreased. Conclusion: Digoxin use is decreasing but there has not been a similar decline in cases of toxicity. Further analyses are required to delineate the reasons underlying these trends and the appropriateness of prescribing practices for both digoxin and its antidote.

Retrospective evaluation of patients with elevated digoxin levels at an emergency department

Turkish Journal of Emergency Medicine, 2016

Objectives: We investigated the demographic characteristics, clinical and laboratory findings, treatment strategies and clinical outcomes of patients presenting at emergency department (ED) with digoxin levels at or above 1.2 ng/ml. Materials and methods: The demographic and clinical characteristics of patients with serum digoxin levels at or above 1.2 ng/ml admitted to an ED between January 2010 and July 2011 were investigated in this cross-sectional descriptive study. Patients with ECG and clinical findings consistent with digoxin toxicity and no additional explanation of their symptoms were evaluated for digoxin toxicity. Results: In this study 137 patients were included, and 68.6% of patients were women with mean age 76.1 ± 12.2. There was no significant difference between gender and digoxin intoxication. The mean age of intoxicated group was significantly higher than the non-intoxicated group (P ¼ 0.03). The most common comorbidities were congestive heart failure (n ¼ 91) and atrial fibrillation (n ¼ 74). The most common symptoms were nausea, vomiting and abdominal pain. The levels of hospitalization and mortality in this group were significantly higher. Conclusion: Digoxin intoxication must be suspected in patients present in the ED, particularly those with complaints that include nausea and vomiting, as well as new ECG changes; serum digoxin levels must be determined.

Therapeutic Drug Monitoring and Population Pharmacokinetics of Digoxin in Jordanian Patients

American Journal of Pharmacological Sciences, 2013

Therapeutic monitoring of digoxin and the population pharmacokinetic parameters in Jordanian patients were done. Fifty three patients visited cardiac department of Jordan University hospital participated in this study, thirty two patients had congestive heart failure (CHF), while twenty one patients had atrial fibrillation (AF). Ninety three blood samples were collected from those patients for the measurement of digoxin level using AxSYM digoxin II assay method. Serum creatinine and potassium levels were also measured, in addition to blood pressure and heart rate. Microsoft Excel and Statistica programs were used for kinetic and statistical analysis. NONMEM computer program ADVAN 4 and 2 compartment model was used for population analysis of digoxin parameters. The serum digoxin level ranged from 0.11-4 ng/ml. The percentage of all patients enrolled in this study that were out of therapeutic range was 49.05%. Serum digoxin levels were out of therapeutic range in 53.12% of patients with CHF and 42.85% in those with AF. The pharmacokinetic parameters for digoxin obtained in this study using traditional methods were: creatinine clearance CLcr (89.78 ± 45.61 ml/min), digoxin actual clearance CL (200.57 ± 154.52 L/day), volume of distribution V (541.57 ± 149.87L), t1/2(2.98 ± 2.05 day), elimination rate constant (0.41± 0.396 day -1 ). A strong correlation was also found between actual digoxin clearance with log dose normalized (R 2 =0.999), and t1/2 (R 2 = 0.875). No correlations were found between the log of the normalized dose and other pharmacokinetic parameters or potassium levels. The population pharmacokinetic parameter for digoxin obtained in this study were: CL (3.34L/h), Vc (3.27L), Vt (123L), inter-compartment clearance Q (72L/h), absorption rate constant KA (1.25h -1 ). In Jordanian patients with either AF or CHF digoxin dose adjustment based on therapeutic drug monitoring principles is recommended. Digoxin pharmacokinetics were similar to those reported in non-Jordanian patients; estimated population pharmacokinetic parameters were in agreement with literature values.

Contemporary use of digoxin in clinical practice

2016

Contact address: Carmen Ginghină, “CC Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania Fundeni Street, no. 258, sector 2, 022328, Bucharest, Romania. Email: carmenginghina2010@gmail.com 1 “Prof. Dr. C. C. Iliescu” Emergency Institute of Cardiovascular Diseases, Bucharest, Romania 2 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania Abstract & aims: Although mortality is the most important clinical endpoint in heart failure (HF) clinical trials, it is now recognized that preventing HF hospitalization is important for patients and healthcare systems. In the Digitalis Investigation Group (DIG) trial, digoxin reduced hospitalization due to heart failure (HF) and improved outcomes in high-risk subgroups of HF patients. In our study, we investigated the contemporary use of digoxin in clinical practice based on current knowledge. Methods and results – We retrospectively studied the medical fi les of 300 patients (58% men, 65±12 years) admitte...