Evaluating the Appropriateness of Digoxin Level Monitoring

Cañas, Fina; Tanasijevic, Milenko J.; Ma’Luf, Nell; Bates, David W.

doi:10.1001/archinte.159.4.363

Cited by 45 publications

(45 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Staff physicians are the Table 1. Appropriateness of digoxin level monitoring (Clague et al, 1983;Mordasini et al, 2002;Canas et al, 1999;Copeland et al, 1992 …”

Section: Methodsmentioning

confidence: 99%

“…The appropriateness criteria used in this study were based on published criteria (Clague et al, 1983;Mordasini et al, 2002;Canas et al, 1999;Copeland et al, 1992) which were reviewed and revised by two expert pharmacists. Digoxin level monitoring was considered appropriate if the following two criteria were met (Table 1): (1) there was an adequate indication for monitoring: adequate indication for monitoring: suspected digoxin toxicity; high risk patient; sub-therapeutic response; initiation of digoxin therapy or dosage adjustment; admission level for inpatients without digoxin determination within previous 9 months; suspected digoxin abuse, and (2) the blood sample was drawn at least six hours after digoxin administration.…”

Section: Development Of Appropriateness Criteriamentioning

confidence: 99%

“…Because of its narrow therapeutic index and large interindividual pharmacokinetic variability, it is important to know digoxin blood levels. However, studies have shown that procedures for digoxin serum concentration monitoring are frequently not within accepted guidelines (Clague et al, 1983;Copeland et al, 1992;Canas et al, 1999;Mordasini et al, 2002;Haim et al, 2002;Sidwell et al, 2003;Puche et al, 2004;Lippi et al, 2007;Orrico et al, 2011). Digoxin level monitoring performed without proper indication or with incorrect timing may not only significantly limit its benefits but also result in toxicity and unnecessary costs.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Appropriateness of digoxin level monitoring in a childrens hospital

Huang¹,

Cao²,

Li³

2012

Afr. J. Pharm. Pharmacol.

View full text Add to dashboard Cite

To evaluate the proportion of inappropriate digoxin level determinations in children at Children's Hospital of Fudan University. A retrospective analysis of 291 digoxin level determinations in 210 inpatients was performed. Appropriateness criteria were based on existing criteria that were revised using local expert opinion. The main outcome measure was the proportion of digoxin levels assessed as inappropriate by these criteria. Of the 291 digoxin levels, 126 (43.3%) were considered inappropriate and the remaining 165 (56.7%), appropriate. For the majority of the inappropriate determinations timing of blood sampling was incorrect (74.6%); the remaining determinations were done without proper indication. Almost half the digoxin blood level monitoring was assessed as inappropriate, mainly because of incorrect timing of sampling. Interventions to ensure that appropriate indications and procedures for serum digoxin determination in children at the Children's Hospital of Fudan University are urgently needed, moreover, special criteria need to be made for children in digoxin blood level monitoring.

show abstract

“…Staff physicians are the Table 1. Appropriateness of digoxin level monitoring (Clague et al, 1983;Mordasini et al, 2002;Canas et al, 1999;Copeland et al, 1992 …”

Section: Methodsmentioning

confidence: 99%

Section: Development Of Appropriateness Criteriamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Appropriateness of digoxin level monitoring in a childrens hospital

Huang¹,

Cao²,

Li³

2012

Afr. J. Pharm. Pharmacol.

View full text Add to dashboard Cite

show abstract

“…1,2 Increasing evidence suggests that the current use of TDM is suboptimal, with up to 70% to 80% of drug quantifications in hospitalized patients being inappropriately performed, primarily because of routine daily monitoring without pharmacological justification. 3,4 Routine vancomycin TDM has been intensely debated, [5][6][7][8][9] and scrutiny has resulted in the publication of consensus guidelines in January 2009 by the American Society of Health-System Pharmacists, the Infectious Disease Society of America, and the Society of Infectious Disease Pharmacists. 1 These guidelines focused specifically on vancomycin TDM in adult patients.…”

Section: Introductionmentioning

confidence: 99%

Inappropriate Vancomycin Therapeutic Drug Monitoring in Hospitalized Pediatric Patients Increases Pediatric Trauma and Hospital Costs

Suryadevara

Steidl

Probst

et al. 2012

The Journal of Pediatric Pharmacology and Therapeutics

View full text Add to dashboard Cite

OBJECTIVES The objective of this study was to measure the appropriateness of vancomycin monitoring in a pediatric tertiary care center and to evaluate the effectiveness of two interventions, autonomous pharmacy therapeutic drug monitoring and health care provider education, in reducing avoidable pediatric patient trauma and hospital cost. METHODS A retrospective chart review evaluating vancomycin therapeutic drug monitoring (TDM) in pediatric inpatients was performed before and after the introduction of an autonomous pharmacy TDM program and health care provider (HCP) education. RESULTS Thirty-five patients were included in our study, prior to any intervention. Of these, 9% of patients had trough concentrations appropriately deferred. Of the total of 64 trough concentrations obtained, 94% were considered to be inappropriate. After the start of the autonomous pharmacy TDM program, of the 54 eligible patients (111 troughs), 9% had trough concentrations appropriately deferred, and 34% were inappropriate. In the 3-month period following the introduction of HCP education in combination with pharmacy TDM, we identified 27 eligible patients. Among those, 15% of the patients had trough concentrations appropriately deferred. Of the 43 trough concentrations obtained, only 9% were considered to be inappropriate. The combination of pharmacy TDM with HCP education decreased annualized hospital cost by 60%, from $13,080 to $5232. CONCLUSIONS Inappropriate vancomycin TDM occurs commonly in our institution, resulting in unnecessary hospital cost and patient trauma. The combination of pharmacy TDM and HCP education significantly improved clinical practice; however, results were short-lived. Further interventions, such as computer based order entry, will likely be needed to reinforce and improve long-term TDM practice in pediatric patients.INDEX TERMS antibiotic stewardship, therapeutic drug monitoring, vancomycin J Pediatr Pharmacol Ther 2012;17(2):159-165

show abstract

“…However, several studies reported that digoxin TDM is frequently performed inappropriately that limits its benefits & increases unnecessary costs [7,9,10,11]. Therefore three criteria for proper use of digoxin TDM were suggested including proper indications, proper sampling time and proper interpretation of the measured digoxin level [12][13][14][15][16][17]. Several population pharmacokinetic of digoxin studies were reported that estimate the pharmacokinetic parameters of digoxin to be used in clinical practice for estimating appropriate dosage regimen [18,19,20,21,22].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Drug Monitoring and Population Pharmacokinetics of Digoxin in Jordanian Patients

Shaker¹,

Hamadi²,

Idkaidek³

et al. 2013

AJPS

View full text Add to dashboard Cite

Therapeutic monitoring of digoxin and the population pharmacokinetic parameters in Jordanian patients were done. Fifty three patients visited cardiac department of Jordan University hospital participated in this study, thirty two patients had congestive heart failure (CHF), while twenty one patients had atrial fibrillation (AF). Ninety three blood samples were collected from those patients for the measurement of digoxin level using AxSYM digoxin II assay method. Serum creatinine and potassium levels were also measured, in addition to blood pressure and heart rate. Microsoft Excel and Statistica programs were used for kinetic and statistical analysis. NONMEM computer program ADVAN 4 and 2 compartment model was used for population analysis of digoxin parameters. The serum digoxin level ranged from 0.11-4 ng/ml. The percentage of all patients enrolled in this study that were out of therapeutic range was 49.05%. Serum digoxin levels were out of therapeutic range in 53.12% of patients with CHF and 42.85% in those with AF. The pharmacokinetic parameters for digoxin obtained in this study using traditional methods were: creatinine clearance CLcr (89.78 ± 45.61 ml/min), digoxin actual clearance CL (200.57 ± 154.52 L/day), volume of distribution V (541.57 ± 149.87L), t1/2(2.98 ± 2.05 day), elimination rate constant (0.41± 0.396 day -1 ). A strong correlation was also found between actual digoxin clearance with log dose normalized (R 2 =0.999), and t1/2 (R 2 = 0.875). No correlations were found between the log of the normalized dose and other pharmacokinetic parameters or potassium levels. The population pharmacokinetic parameter for digoxin obtained in this study were: CL (3.34L/h), Vc (3.27L), Vt (123L), inter-compartment clearance Q (72L/h), absorption rate constant KA (1.25h -1 ). In Jordanian patients with either AF or CHF digoxin dose adjustment based on therapeutic drug monitoring principles is recommended. Digoxin pharmacokinetics were similar to those reported in non-Jordanian patients; estimated population pharmacokinetic parameters were in agreement with literature values.

show abstract

Evaluating the Appropriateness of Digoxin Level Monitoring

Cited by 45 publications

References 25 publications

Appropriateness of digoxin level monitoring in a childrens hospital

Appropriateness of digoxin level monitoring in a childrens hospital

Inappropriate Vancomycin Therapeutic Drug Monitoring in Hospitalized Pediatric Patients Increases Pediatric Trauma and Hospital Costs

Therapeutic Drug Monitoring and Population Pharmacokinetics of Digoxin in Jordanian Patients

Contact Info

Product

Resources

About