Determination of Digoxin Clearance in Japanese Elderly Patients for Optimization of Drug Therapy

Abstract

We developed a new model for elderly patient dosing of digoxin with good predictive performance. Clinical application of the findings of the present study to patient care may permit selection of an appropriate initial digoxin maintenance dose, thus enabling the clinician to achieve a desired therapeutic effect. However, the digoxin dosage regimen should be based on an appraisal of the individual patient's clinical need for the drug.

Study of digoxin use in a public health unit

“…Literature demonstrates a progressive increase in serum digoxin levels related to a decrease of digitalis renal clearance due to age (Souza et al 2013, Yukawa et al 2011. The reduction of digoxin clearance to about 50% of its normal value (0.80 mL/ min/kg) results in an increased half-life (Yukawa et al 2011), which can favor values of Cp out of the therapeutic range, as observed in this study with patients with renal failure using digitalis (33%).…”

“…The reduction of digoxin clearance to about 50% of its normal value (0.80 mL/ min/kg) results in an increased half-life (Yukawa et al 2011), which can favor values of Cp out of the therapeutic range, as observed in this study with patients with renal failure using digitalis (33%).…”

Improvement of Adequate Digoxin Dosage: An Application of Machine Learning Approach

“…Previous studies have employed statistical models [1, 2, 20, 22, 25] and pharmacokinetics [18, 21, 23, 26, 28, 29, 31–36], and data mining and machine learning techniques have only recently been adopted to improve model predictability [8, 24]. This study investigated decision tree-based approaches, which were identified to exhibit an average performance superior to that of other techniques.…”

“…Previous studies showed that digoxin absorption is slower, and peak concentration is lower in patients with CHF than in healthy volunteers due to reduced gastrointestinal motility, congestion in the gut wall, and reduced splanchnic blood flow in patients with CHF [54–56], thereby causing changes of SDC. Finally, DDI involving high-alert medications has gained considerable attention in the field of medicine, particularly digoxin, which has a narrow therapeutic concentration range [2, 8, 18, 20, 23, 24, 27–31, 34–36]. DDI involving digoxin can easily lead to an elevated SDC and subsequent toxicity reaction [57].…”

Guidelines for Therapeutic Drug Monitoring of Cardiovascular Drugs Clinical Use of Blood Drug Concentration Monitoring (JCS 2015) ― Digest Version ―

“…111 Although the effects of aging on renal function and muscle mass differ among individuals, digoxin therapy should be planned individually according to the patient's renal function, and the dose and dosing interval should be adjusted via TDM. Patients should be instructed to visit the clinic when they have nausea, anorexia, diarrhea, confusion, disorientation, visual impairment, and/ or severe bradycardia, which suggest digoxin intoxication.…”