Inappropriate digoxin monitoring

Abstract

The digoxin therapeutic drug monitoring service was evaluated during a 7-week period at Leeds General Infirmary. Data were collected for 88 patients who had one or more assays performed. The requesting clinician was contacted for each assay, and a questionnaire completed. Results were assessed to determine the appropriateness of the assay request and the action taken following receipt of the result. During the assessment period, 113 serum digoxin assays were requested. Data were collected for 88 (78%) of these, of which 22 (25%) were considered to have met all the criteria for an appropriate assay request and subsequent action. A total of 66 (75%) serum digoxin assays were assessed as wasted. The digoxin therapeutic drug monitoring service is used inappropriately at Leeds General Infirmary.

Appropriateness of digoxin level monitoring in a childrens hospital

“…Rational use of therapeutic drug monitoring can help determine appropriate drug dosage and avoid toxic reactions. However, in previous studies the proportion of inappropriate monitoring ranged from 32 to 84% (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), suggesting that digoxin TDM is a tool that is difficult to use correctly. In these studies there was some variation in the criteria by which the quality of monitoring was assessed, making it difficult to directly compare findings.…”

“…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 …”

“…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.…”

“…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.…”

Therapeutic Drug Monitoring and Population Pharmacokinetics of Digoxin in Jordanian Patients

“…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].…”