Br Med J 3: — PubMed Google Scholar. Chung EK Digitalis intoxication. Williams and Wilkins, Baltimore, pp 1—2. Pharmacology and the future of man. Karger, Basel, pp — Br Heart J — Clin Pharmacokinet 1: 36— Jeliffe RW An improved method of digoxin therapy. Ann Intern Med — A comparison between intuitive and assisted dose selection. Eur J Clin Pharmacol — J Pharmacokinet Biopharm 3: — Clin Pharmacol Ther 9— Radioimmunoassay and disposition pharmacokinetics of digoxin after intravenous administration.
Acta Pharm Suec 2: — Clin Nephrol — Rabkin SW, Grupp G A two compartment open model for digoxin pharmacokinetics in patients receiving a wide range of digoxin doses. Acta Cardiol — Pharmacologie effect kinetics and apparent volume of distribution. J Clin Pharmacol — Sachs L Angewandte Statistik. Springer, Berlin Heidelberg New York. Wagner JG Loading and maintenance doses of digoxin in patients with normal renal function and those with severly impaired renal function.
J Clin Pharmacol — Download references. Department of Medicine, University of Bern, Switzerland. Ohnhaus, H. You can also search for this author in PubMed Google Scholar. Reprints and Permissions. Ohnhaus, E. Comparison of two different loading doses of digoxin in severe renal impairment. In this study, 87 patients aged 31 to 92 years were hospitalized in the cardiac care unit and after obtaining informed written consent, they were included in the study.
Blood sample was drawn to assess digoxin concentration 6 to 12h after last digoxin administration. Patients with hypothyroidism hypothyroidism or hyperthyroidism , renal replacement therapy, digoxin use in the last two weeks, acute renal failure, concomitant use of amiodarone, calcium channel blockers, quinine, quinidine, macrolides and cyclosporine consumption, weight over kg, age under 18, pregnant women, death during the study and dissatisfaction with the study were excluded.
Statistical Analysis was performed using the Pearson correlation. Kai square, Fisher, T-test and independent multivariate analysis were used. During the study period, 87 patients aged 31 to 92 years, with a mean age of Mean GFR of patients was Also, meanserum digoxin concentration level after loading dose was 1.
The mean serum digoxin concentration was measured as follows: stage 2 0. There was a significant correlation between serum digoxin concentration and serum magnesium level 2. Laboratory findings of different groups and correlation with Digoxin therapeutic concentration are shown in the Table 2. There was no significant differences between clinical signs of digoxin toxicity like nausea and vomiting between groups.
It was also shown that although there was a significant correlation between digoxin levels and magnesium and sodium levelin two groups , correlations with different stages of renal function GFR were not observed.
These results are the same as reported in similar studies [17,18]. Digoxin, as a digitalis glycoside, improves the hemodynamic and neurohormonal perturbations which plays a crucial role in Heart Failure HF induced renal dysfunction. Abnormal energy metabolism increased production of reactive oxygen species ROS , and defects in excitation-contraction are the hallmarks of Heart Failure due to impaired ventricular filling or blood ejection[19,20].
However, our study did not show a significant relationship between sodium and potassium levels with digoxin levels, which may be due to minor changes in the levels of electrolytes. However, the difference in sodium levels between the two groups with Digoxin therapeutic and toxicity concentration, was significant. A case-control study of patients who took digoxin for a long time and had a toxic level compared with those who recently received a therapeutic dose of digoxin reported that There were no differences between case and control groups with creatinine, age, or sex [22].
The findings show that there is a significant direct link between magnesium and digoxin. These results were inconsistent with the study by Young IS et al that examined the relationship between serum magnesium levels and digoxin toxicity.
Results demonstrated that magnesium deficiency was the most common electrolyte disorder associated with digoxin toxicity [23]. The results of this study show the importance of monitoring patients receiving a loading dose of digoxin and have renal dysfunction.
Inflammation, oxidative stress, impaired hydro saline homeostasis, and diuretic resistance are common mechanisms in heart failure and kidney dysfunction which lead to worsen diseases prognosis [24]. Also The results of a study by Voors, AA, et al. While heart failure progresses, decrease arterial pressure combined with an increase in venous pressure leads to glomerular filtration declines.
Preventing the development of kidney damage in patients with cardiac disorders is a major challenge [27]. The glomerular filtration rate GFR , serum electrolyte values and Creatinine levels are used to monitor chronic kidney disease [28]. GFR less than A study in introduced urea and serum creatinine as the best criteria for predicting mortality in patients with chronic digoxin poisoning [30]. A study in California of 41 patients receiving digoxin with blood urea nitrogen RUN , Another study was done on patients ranging in age from 22 to 88 years with serum creatinine ranged from 0.
Drugs including amiodarone, verapamil, diltiazem, nifedipine, quinidine, quinine, clarithromycin, azithromycin, and erythromycin, tetracycline, and cyclosporine could influence digoxin concentration [33]. Hypokalemia, hypomagnesemia, hypercalcemia, myocardial ischemia, hypoxemia, and acid-base disturbances are conditions that increase the serum digoxin concentration which may cause toxicity. Long-term therapy with digoxin can lead to overdose and emergent condition [34,35].
Bradycardia and life-threatening ventricular arrhythmias are results of Digoxin toxicity. The results of these studies confirm the result of the present study. Our prospective study has some limitations because it was a Hospital-Based Study with a limited sample size and some of the data like causes of «toxic» digoxin concentrations are not available. This study emphasize on importance of weight adjusted doseselection ofdigoxin not only in the maintenance dose but also in the bolus dose and demonstrated that monitoring plasma Digoxin concentration after an appropriate and measured intravenous loading dose in patients with renal failure can be very helpful to prevent digoxin toxicity.
By checking the serum level of digoxin during treatment and the level of serum electrolytes, including magnesium, it can be ensured that no digoxin poisoning will occur, and in cases with digoxin toxic symptoms, the necessary procedures are taken. Order for reprints.
Toggle navigation. ISSN: Author and article information. DOI : Arch Clin Nephrol 7 1 : DOI: Indexing and Abstracting. Main article text. Introduction Digoxin is one of the frequently prescribed medications with a narrow therapeutic range and many drug interactions [1,2].
Thus, renal dysfunction is common in heart failure patients and can increase related mortality especially in GFR. Table 1: correlation between serum digoxin concentration with demographic and clinical characteristic. Arch Intern Med BMC Med 2: 8. A neurohormonal modulator in heart failure?. Circulation Am J Med J Thorac Cardiovasc Surg
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