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. 1977 Jun;4(3):327–335.

Digoxin prescribing in perspective

Sylvia M Dobbs, Elaine M Rodgers, W I Kenyon, D Livshin, E Slater, Bernice Godsmark
PMCID: PMC1429068

Abstract

1 Prescribing aids based on creatinine clearance were evaluated in 86 out-patients taking digoxin at a district general hospital. Lanoxin tablets were dispensed in calendar packs to encourage patient compliance.

2 Despite a high degree of patient compliance and a more than three-fold variation in creatinine clearance the range of concentrations that would result from prescribing individual doses based on creatinine clearance was similar to that expected from prescribing one fixed dose for all male and another for all female patients.

3 Concentrations at which symptoms of toxicity occurred in 31 patients did not differ significantly from concentrations achieved in the remainder.

4 Only 17% of the variance in resting ventricular rate in patients with atrial fibrillation and no serious impairment of atrio-ventricular conduction was explained by the serum digoxin concentration.

5 Even when the serum digoxin concentration is known the patient's clinical condition must be the final determinant of dose.

6 Patients with symptoms of toxicity were distinguished by significantly lower serum creatinine concentrations and body weights, factors suggestive of a lower muscle mass. No other biochemical or clinical (other than serum digoxin concentration) factors influencing resting ventricular rate in atrial fibrillation were identified.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andersson K. E., Bertler A., Wettrell G. Post-mortem distribution and tissue concentrations of digoxin in infants and adults. Acta Paediatr Scand. 1975 May;64(3):497–504. doi: 10.1111/j.1651-2227.1975.tb03871.x. [DOI] [PubMed] [Google Scholar]
  2. Beller G. A., Smith T. W., Abelmann W. H., Haber E., Hood W. B., Jr Digitalis intoxication. A prospective clinical study with serum level correlations. N Engl J Med. 1971 May 6;284(18):989–997. doi: 10.1056/NEJM197105062841801. [DOI] [PubMed] [Google Scholar]
  3. Chamberlain D. A., White R. J., Howard M. R., Smith T. W. Plasma digoxin concentrations in patients with atrial fibrillation. Br Med J. 1970 Aug 22;3(5720):429–432. doi: 10.1136/bmj.3.5720.429. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dettli L., Spring P., Ryter S. Multiple dose kinetics and drug dosage in patients with kidney disease. Acta Pharmacol Toxicol (Copenh) 1971;29 (Suppl 3):211–224. doi: 10.1111/j.1600-0773.1971.tb03301.x. [DOI] [PubMed] [Google Scholar]
  5. Dobbs S. M., Mawer G. E., Rodgers M., Woodcock B. G., Lucas S. B. Can digoxin dose requirements be predicted? Br J Clin Pharmacol. 1976 Apr;3(2):231–237. doi: 10.1111/j.1365-2125.1976.tb00597.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dobbs S. M., Parkes J., Rodgers E. M. Digoxin: linearity between dose and serum concentration. Br J Clin Pharmacol. 1976 Oct;3(5):940–941. doi: 10.1111/j.1365-2125.1976.tb00653.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Evered D. C., Chapman C., Hayter C. J. Measurement of plasma digoxin concentration by radioimmunoassay. Br Med J. 1970 Aug 22;3(5720):427–428. doi: 10.1136/bmj.3.5720.427. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Fogelman A. M., La Mont J. T., Finkelstein S., Rado E., Pearce M. L. Fallibility of plasma-digoxin in differentiating toxic from non-toxic patients. Lancet. 1971 Oct 2;2(7727):727–729. doi: 10.1016/s0140-6736(71)92100-3. [DOI] [PubMed] [Google Scholar]
  9. Harrison C. E., Jr, Brandenburg R. O., Ongley P. A., Orvis A. L., Owen C. A., Jr The distribution and excretion of tritiated substances in experimental animals following the administration of digoxin-3H. J Lab Clin Med. 1966 May;67(5):764–777. [PubMed] [Google Scholar]
  10. Howard D., Smith C. I., Stewart G., Vadas M., Tiller D. J., Hensley W. J., Richards J. G. A prospective survey of the incidence of cardiac intoxication with digitalis in patients being admitted to hospital and correlation with serum digoxin levels. Aust N Z J Med. 1973 Jun;3(3):279–284. doi: 10.1111/j.1445-5994.1973.tb03096.x. [DOI] [PubMed] [Google Scholar]
  11. Jelliffe R. W., Brooker G. A nomogram for digoxin therapy. Am J Med. 1974 Jul;57(1):63–68. doi: 10.1016/0002-9343(74)90769-4. [DOI] [PubMed] [Google Scholar]
  12. Lely A. H., van Enter C. H. Large-scale digitoxin intoxication. Br Med J. 1970 Sep 26;3(5725):737–740. doi: 10.1136/bmj.3.5725.737. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Redfors A. Plasma digoxin concentration--its relation to digoxin dosage and clinical effects in patients with atrial fibrillation. Br Heart J. 1972 Apr;34(4):383–391. doi: 10.1136/hrt.34.4.383. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Sheiner L. B., Halkin H., Peck C., Rosenberg B., Melmon K. L. Improved computer-assisted digoxin therapy. A method using feedback of measured serum digoxin concentrations. Ann Intern Med. 1975 May;82(5):619–627. doi: 10.7326/0003-4819-82-5-619. [DOI] [PubMed] [Google Scholar]
  15. Sheiner L. B., Rosenberg B., Marathe V. V., Peck C. Differences in serum digoxin concentrations between outpatients and inpatients: an effect of compliance? Clin Pharmacol Ther. 1974 Mar;15(3):239–246. doi: 10.1002/cpt1974153239. [DOI] [PubMed] [Google Scholar]
  16. Sheiner L. B., Rosenberg B., Melmon K. L. Modelling of individual pharmacokinetics for computer-aided drug dosage. Comput Biomed Res. 1972 Oct;5(5):411–459. doi: 10.1016/0010-4809(72)90051-1. [DOI] [PubMed] [Google Scholar]
  17. Siersbaek-Nielsen K., Hansen J. M., Kampmann J., Kristensen M. Rapid evaluation of creatinine clearance. Lancet. 1971 May 29;1(7709):1133–1134. doi: 10.1016/s0140-6736(71)91873-3. [DOI] [PubMed] [Google Scholar]
  18. Singh R. B., Rai A. N., Dube D. P., Srivastav D. K., Somani P. N., Katiyar B. C. Radioimmunoassay of serum digoxin in relation to digoxin intoxication. Br Heart J. 1975 Jun;37(6):619–623. doi: 10.1136/hrt.37.6.619. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Smith T. W., Haber E. Digoxin intoxication: the relationship of clinical presentation to serum digoxin concentration. J Clin Invest. 1970 Dec;49(12):2377–2386. doi: 10.1172/JCI106457. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Weintraub M., Au W. Y., Lasagna L. Compliance as a determinant of serum digoxin concentration. JAMA. 1973 Apr 23;224(4):481–485. [PubMed] [Google Scholar]

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