Table 1.
Serum digoxin concentrations: selected reference therapeutic trough ranges
| Resource | Range (ng/ml) |
|---|---|
| Online/electronic references | |
| POISINDEX® | 0.6–2.6* |
| Lexi-Comp® | 0.5–0.8† |
| UpToDate® | 0.5–0.8†; 0.8–2.0§§ |
| DynaMed™ | 0.5–2.0 |
| Epocrates | 0.5–0.8†; 0.8–2.0‡§ |
| DRUGDEX® | 0.8–2.0• |
| Specialty society heart failure guidelines | |
| American College of Cardiology/American Heart Association 2005 guideline update | 0.5–1.0 |
| European Society of Cardiology 2008 | 0.6–1.2 |
| Reference textbooks | |
| Braunwald’s Heart Disease, 9th Ed., 2012 | <1.0†; 0.5–1.0†; 0.8–2.0‡¶ |
| Goldman’s Cecil Medicine, 24th Ed., 2012 | 0.5–1.0¶¶ |
| Harrison’s Principles of Internal Medicine, 18th Ed., 2012 | <1.0# |
| Tintinalli’s Emergency Medicine, 7th Ed., 2011 | 0.5–2.0 |
| Rosen’s Emergency Medicine, 7th Ed., 2010 | 0.7–1.1†## |
| Goldfrank’s Toxicologic Emergencies, 9th Ed., 2010 | 0.5–2.0** |
| Physicians’ Desk Reference, 2011 | 0.8–2.0†† |
| Pharmacotherapy: A Pathophysiologic Approach, 8th Ed., 2011 | 0.5–1.0 |
| 2012 CURRENT Medical Diagnosis and Treatment | 0.5–0.9†; 0.5–2.0†∞ |
| Conn’s Current Therapy, 2012 | 0.6–2.0 |
| Oxford Textbook of Primary Medical Care, 2011 | 1.0–2.0 |
| Hurst’s The Heart, 13th Ed., 2011 | 0.5–1.1 |
| Commercial laboratory | |
| Quest Diagnostics | 0.8–2.0 |
Notes that toxicity has been reported within this “normal” therapeutic serum digoxin concentration.
Range cited for heart failure.
Range cited for control of ventricular response with atrial tachyarrhythmias.
Notes that “arrhythmias may require higher level.”
“Effective serum or plasma concentration” for atrial tachyarrhythmias.
Range cited in the text for treating heart failure, but table on “toxicology and therapeutic drug monitoring” cites a therapeutic range of 0.5 to 2.0 ng/ml, with toxicity at >3.9 ng/ml.
Level cited for “most institutions.” Specifies that current evidence suggests upper limits of 1.0 ng/ml.
Notes that about 2/3 of adults considered adequately digitalized (without evidence of toxicity) have serum drug concentrations ranging from 0.8 to 2.0 ng/ml but that concentrations of 0.5 to 1.0 ng/ml may be “appropriate.”
Range cited in the text, but table in Appendix “Drugs: Therapeutic and Toxic” cites a therapeutic range of 0.8 to 1.5 ng/ml, a range for CHF and arrhythmias as 1.5 to 2.0 ng/ml, and a toxic range of >2.5 ng/ml.
Therapeutic range in chapter on Digitalis (Cardiac Glycoside) Poisoning.
Notes that the positive inotropic effect is apparent with serum digoxin levels between 0.7 ng/mL and 1.2 ng/mL, and levels above this range may be associated with a higher risk of arrhythmias and lower survival rates.
Serum steady-state digoxin levels of 1.1 to 3.0 ng/mL are equivocal.
This level is based on the Product Information for Lanoxin®, from Glaxo Wellcome, Inc.