Management of digoxin therapy using pharmacokinetics in a patient undergoing continuous venovenous hemofiltration

Benken, Scott; Lizza, Bryan; Yamout, Hala; Ghossein, Cybele

doi:10.2146/ajhp130171

Cited by 6 publications

(6 citation statements)

References 17 publications

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“…The majority (50-70%) of digoxin is renally eliminated, unchanged in a linear fashion, highlighting the importance of dose adjustment in renal dysfunction [21,22]. Guidance regarding dosage adjustments in iHD and CRRT are scarce, with current recommendations suggesting to administer 50% of the loading dose followed by administering 62.5mcg every 48 hours for iHD or 62.5 mcg -125 mcg every 48 hours for CRRT [4,7]. Monitoring digoxin in patients that are on chronic digoxin is important as it has a narrow therapeutic index, with a goal of serum level of 0.8-1.2 ng/mL for A b and 0.5-0.7 ng/ml for heart failure [23,24].…”

Section: Discussionmentioning

confidence: 99%

“…A case report by Benken et al sought to investigate the effects of continuous venovenous hemo ltration (CVVH) on digoxin clearance [4]. The researchers calculated the sieving coe cient and transmembrane clearance for digoxin to be 0.8 and 30 mls/min, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Speci cally, the hemodynamic instability of patients in A b-RVR may preclude the use of traditional agents such as beta blockers and calcium channel blockers [3]. Amiodarone may be utilized in the hemodynamically unstable patient with a success rate of pharmacological cardioversion of approximately 70% [4]. Although less effective than other agents, the utility of digoxin in A b-RVR may be an alternate treatment option in which the aforementioned therapies are contraindicated or ineffective in the management of A b-RVR [5].…”

Section: Introductionmentioning

confidence: 99%

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Safety of Digoxin Loading in Patients Undergoing Continuous Renal Replacement Therapy.

Rubino

Mahmoud

2023

Preprint

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Background: Atrial fibrillation with rapid ventricular response (Afib-RVR) is a hemodynamically unstable arrythmia encountered in the critically ill patient. Digoxin, a cardiac glycoside, may be an appropriate treatment option for managing Afib-RVR with contraindications or unresponsiveness to traditional agents. Currently, there is limited guidance for the use of digoxin supported with continuous renal replacement therapy (CRRT). Aim: The primary outcome of this study is the incidence of bradycardia (Heart rate less than 60 beats per minute) within 48 hours following digoxin initiation. Secondary outcomes include the time to achieve rate control after digoxin initiation and the proportion of time rate controlled within the first 48 hours of digoxin therapy. Methods: This was a retrospective study of patients admitted to an intensive care unit between March 2018 and October 2021 with a diagnosis of Afib-RVR, received a digoxin loading dose while supported with CRRT. Exclusion criteria included prior digoxin use, use other than Afib-RVR concurrent beta-blocker or calcium-channel blocker therapy. Results: Nine patients met the inclusion criteria, there were no incidences of bradycardia within the first 48 hours following digoxin initiation. The median digoxin loading dose, time to rate control and proportion with rate control was 9.01 ± 2.04 mcg/kg, 7±13 hours and 54 ± 23% respectively. Conclusions: In our cohort of patients in Afib-RVR loaded with digoxin while supported on CRRT did not experience any bradycardic episodes. This data supports a cautious approach to digoxin use in this patient population and serves as a platform for future studies for the optimal dosing regimen.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Safety of Digoxin Loading in Patients Undergoing Continuous Renal Replacement Therapy.

Rubino

Mahmoud

2023

Preprint

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“…Kaneko et al showed successful treatment of digoxin toxicity with hemoperfusion using a specific column for β2‐microglobulin‐adsorption in a hemodialysis patient but the availability of the column and lack of trials are the main concerns about this modality 7 . Benken et al investigated the pharmacokinetics of digoxin and showed a decrease in serum digoxin concentrations with continuous venovenous hemofiltration in a heart failure patient without any drug toxicity 8 . We report, for the first time in the literature, a case of acute severe digoxin toxicity with severe acute kidney injury who was successfully treated with CVVHD treatment.…”

Section: Discussionmentioning

confidence: 99%

“…7 Benken et al investigated the pharmacokinetics of digoxin and showed a decrease in serum digoxin concentrations with continuous venovenous hemofiltration in a heart failure patient without any drug toxicity. 8 We report, for the first time in the literature, a case of acute severe digoxin toxicity with severe acute kidney injury who was successfully treated with CVVHD treatment.…”

Section: Continuous Hemodialysis In Digoxin Toxicitymentioning

confidence: 97%

Continuous venovenous hemodialysis may be effective in digoxin removal in digoxin toxicity: A case report

Gokalp

Doğan

AYGÜN

et al. 2020

Hemodialysis International

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Digoxin is a cardiac glycoside that is used for the treatment of heart failure and atrial fibrillation. Besides its careful close follow-up, toxicity affects nearly 1% of congestive heart failure patients. Cessation of the drug, appropriate electrolyte and rhythm control and digoxin-Fab antibody are the mainstay for toxicity treatment in these patients. As known, hemodialysis and peritoneal dialysis are not effective by the means of digoxin removal. We present a 66-year-old patient who admitted to hospital with digoxin toxicity and severe acute kidney injury. The patient was treated with continuous venovenous hemodialysis because of her hypervolemia, hyperkalemia, cardiac instability, and the thought of probable decrease in digoxin levels concerning the continuous nature of solute clearance. Without the treatment using digoxin-specific Fab antibodies, the patient's digoxin level was decreased successfully with continuous venovenous hemodialysis. In conclusion, continuous venovenous hemodialysis may be a treatment option in digoxin toxicity especially those who suffer from severe renal dysfunction and cannot access digoxin antidote.

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Drug Administration and Pharmacogenomics in Children Receiving Acute or Chronic Renal Replacement Therapy

Blowey¹,

Leeder²,

Blowey³

2021

Pediatric Dialysis

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Management of digoxin therapy using pharmacokinetics in a patient undergoing continuous venovenous hemofiltration

Abstract: Analysis of serum digoxin concentration and digoxin Cuf values suggested that digoxin was cleared by CVVH, allowed calculation of Sc and CLtm values, and facilitated determination of digoxin requirements in a critically ill patient requiring CVVH.

Cited by 6 publications

References 17 publications

Safety of Digoxin Loading in Patients Undergoing Continuous Renal Replacement Therapy.

Safety of Digoxin Loading in Patients Undergoing Continuous Renal Replacement Therapy.

Continuous venovenous hemodialysis may be effective in digoxin removal in digoxin toxicity: A case report

Drug Administration and Pharmacogenomics in Children Receiving Acute or Chronic Renal Replacement Therapy

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