Summary
37 patients on maintenance digoxin therapy were observed in hospital over an 8 day period. From day 1 to day 8 measurements of plasma digoxin and serum creatinine indicated that these patients were in the equilibrium state with regard to digoxin levels and renal function. Assuming a linear relationship between dose and plasma concentration, it was possible to calculate the doses which would have produced plasma concentrations of 1.5 ng/ml, and at the limits of the ‘usual therapeutic range’, 0.8 and 2.0 ng/ml. Doses obtained from six prescribing aids and those prescribed intuitively by the doctor were then compared. None of the methods used would have resulted in plasma digoxin concentrations within the ‘usual therapeutic range’ in more than 57% of the patients. The physicians' intuitive choice appeared to be better than the doses estimated from prescribing aids, in that they were correct as often as any assisted method, and when wrong tended to prescribe ‘too low’ rather than ‘too high’. The prescribing aids tended to overestimate dosage in many patients, as high as 65% with one. Plasma digoxin concentration measurement would appear to be the only way to ensure adequate therapeutic efficacy and avoid toxicity in patients receiving maintenance digoxin.
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References
Aronson, J. K.: Monitoring digoxin therapy: 111. How useful are the nomograms? Br. J. Clin. Pharmacol.5, 55–64 (1978)
Carruthers, S. G., Kelly, J. G., McDevitt, D. G.: Plasma digoxin concentrations in patients on admission to hospital. Br. Heart J.36, 707–712 (1974)
Chamberlain, D. A., White, R. J., Howard, M. R., Smith, T. W.: Plasma digoxin concentrations in patients with atrial fibrillation. Br. Med. J.1970/III, 429–432
Dobbs, S. M., Mawer, G. E., Rodgers, E. M., Woodcock, B. J., Lucas, S. B.: Can maintenance digoxin dose requirements be predicted? Br. J. Clin. Pharmacol.3, 231–237 (1976a)
Dobbs, S. M., Parkes, J., Rodgers, E. M.: Digoxin: Linearity between dose and serum concentration. Br. J. Clin. Pharmacol.3, 940–941 (1976b)
Dobbs, S. M., Nicholson, P. W., Rodgers, E. M., Mawer, G. E. and Kenyon, W. I.: Digoxin Prescribing: an evaluation of clinical judgement. Brit. Med. J.1978/II, 668–669
Dobbs, S. M., Rodgers, E. M., Kenyon, W. I., Livshin, D., Slater, E., Godsmark, B.: Digoxin prescribing in perspective. Br. J. Clin. Pharmacol.4, 327–335 (1977)
Doherty, J. E., Kane, J. J.: Clinical pharmacology of digitalis glycosides. Ann. Rev. Med. Greger, W. P., Coggins, C. H., Hancock, E. W., (eds.), pp. 159–171. Annual Reviews Inc. 1975
Evered, D. C., and Chapman, C.: Plasma digoxin concentrations and digoxin toxicity in hospital patients. Br. Heart J.33, 540–545 (1971)
Halkin, H., Sheiner, L. B., Peck, C. C., and Melmon, K. L.: Determinants of the renal clearance of digoxin. Clin. Pharmacol. Ther.17, 385–394 (1975)
Jeliffe, R. W.: Factors to consider in planning digoxin therapy. J. Chronic Dis.24, 407–409 (1971)
Jeliffe, R. W., Brooker, G.: A nomogram for digoxin therapy. Am. J. Med.57, 63–68 (1974)
Johnston, G. D., Kelly, J. G., McDevitt, D. G.: Do patients take digoxin? Br. Heart J.40, 1–7 (1978)
Johnston, G. D., McDevitt, D. G.: Variations of plasma digoxin concentrations in the equilibrium state after multiple dosing. Br. J. Clin. Pharmacol.5, 92–93 (1978a)
Johnston, G. D., McDevitt, D. G.: Digoxin compliance in patients from general practice. Br. J. Clin. Pharmacol.6, 339–343 (1978b)
Johnston, G. D., McDevitt, D. G.: Is maintenance digoxin necessary in patients with sinus rhythm? Lancet1979/I, 567–570
Koup, J. R., Jusko, W. J., Elwood, C. M., Kohli, R. K.: Digoxin pharmacokinetics: Role of renal failure in dosage regimen design. Clin. Pharmacol. Ther.18, 9–21 (1975)
McDevitt, D. G., Johnston, G. D.: Digitalis. Compliance as a factor in drug utilisation. In: Advances in pharmacology and therapeutics. Biochemical Clinical Pharmacology, Tillement, J. P. (ed.), Vol. 7, pp. 77–87. Oxford, New York: Pergamon Press 1978
Manninen, V., Apajalahti, A., Melin, J., Karesoja, M.: Altered absorption of digoxin in patients given propantheline and metoclopramide. Lancet1973/I, 398–400
Mawer, G. E.: Computer assisted prescribing of drugs. Clin. Pharmacokinet.1, 67–78 (1976)
Mawer, G. E.: Unpublished observations (1974)
Ojala, K., Karjalainen, J., Reissell, P.: Radioimmunoassay of digoxin. Lancet1972/I, 150
Peck, C. C., Sheiner, L. B., Martin, C. M., Combs, D. T., Melmon, K. L.: Computer assisted digoxin therapy, N. Engl. J. Med.289, 441–446 (1973)
Redfors, A.: Plasma digoxin concentration — its relation to digoxin dosage and clinical effects in patients with atrial fibrillation. Br. Heart J.34, 383–391 (1972)
Saleh, A. H. K.: The uptake of digoxin and digitoxin by some antacids. J. Pharm. Pharmacol.26, 961–967 (1974)
Siersback-Nielsen, K., Molholm Hansen, J., Kampmann, J., Kristensen, M.: Rapid evaluation of creatinine clearance. Lancet1971/I, 1133–1134
Steiness, E.: Renal tubular secretion of digoxin. Circulation50, 103–107 (1974)
Sumner, D. J., Russell, A. J., Whiting, B.: Digoxin pharmacokinetics: Multicompartmental analysis and its clinical implications. Br. J. Clin. Pharmacol.3, 221–229 (1976)
Wagner, J. G., Yates, J. D., Willis, P. W., Sakmar, E., and Stoll, R. G.: Correlation of plasma levels of digoxin in cardiac patients with dose and measures of renal function. Clin. Pharmacol. Ther.15, 291–301 (1973)
Whiting, B., Sumner, D. J., Goldberg, A.: An assessment of digoxin radioimmunoassay. Scott. Med. J.18, 69–74 (1973)
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Johnston, G.D., Harron, D.W.G. & McDevitt, D.G. Can digoxin prescribing be improved? A comparison between intuitive and assisted dose selection. Eur J Clin Pharmacol 16, 229–235 (1979). https://doi.org/10.1007/BF00608400
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DOI: https://doi.org/10.1007/BF00608400