Safety and Efficacy of Digoxin Therapy—Where Are We Now?

Bajraktarevic, Adnan

doi:10.17265/2328-2150/2016.03.004

Cited by 3 publications

(2 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Considering the narrow therapeutic range and limited availability of serum digoxin measurements, a digoxin 'holiday' is given where the patient is given the dose 5-6 days a week to minimise digoxin toxicity due to the lack of therapeutic drug monitoring. [19] It is not clear whether this 'holiday' is justified in all cases since digoxin plasma levels might decrease to below therapeutic levels. [20,21] Despite this fact, 'digoxin holiday' is frequently used in many countries.…”

Section: Rationale Behind Digoxin Holidaymentioning

confidence: 99%

Digoxin Holiday

Mardikar¹,

Khandekar²

2022

VJIM

View full text Add to dashboard Cite

Digoxin is used in clinical practice for two major purposes: To improve ventricular performance in heart failure with reduced ejection fraction and to control the ventricular rate in atrial fibrillation. It is a cardiac glycoside with a positive inotropic effect and causes atrioventricular nodal inhibition through vagomimetic effect. It also decreases the sympathetic drive generated by the failing circulation, which provides a rational in using the drug in congestive heart failure (CHF) with sinus rhythm. The use of this drug is a standard therapy in the treatment of CHF with atrial fibrillation. However, the dose adjustment of this drug is difficult because of the variation in its pharmacokinetic characteristics, the variability in its clearance, and the lack of a good relationship between the dose and the desired effect and its narrow therapeutic range. This creates difficulty for clinicians to choose the appropriate dosage of the drug to get the desired benefit without the risk of toxicity. In many countries, serum concentration monitoring is not always possible, so it is common in clinical practice to drop the medication for 1 or 2 days a week, giving the drug a ‘holiday,’ to avoid the risk of toxicity. This is contrary to the use of this drug without interruption in countries where routine serum concentration monitoring is possible. This review provides a summary of the evidence relating to the rationale behind using digoxin holiday and the therapeutic implications of digoxin holiday. Much of the information is available from prospective crossover clinical trials. There are no randomised control trials of digoxin holiday in patients with heart failure and/or atrial fibrillation.

show abstract

Section: Rationale Behind Digoxin Holidaymentioning

confidence: 99%

Digoxin Holiday

Mardikar¹,

Khandekar²

2022

VJIM

View full text Add to dashboard Cite

show abstract

“…42 Kadar digoksin di dalam darah sebesar >2 ng/mL tidak menunjukkan adanya tanda toksisitas. 30 Namun, perlu adanya kewaspadaan apabila kadar digoksin di dalam darah mencapai >2 ng/mL, hal ini disebabkan kadar digoksin di dalam darah yang mencapai >3 ng/mL dapat menyebabkan toksisitas pada pasien. 16 Kadar fenitoin di dalam darah yang memiliki rentang kadar terapi (10-20 mg/L) dapat menimbulkan ADR seperti mual yang dapat terjadi selama menggunakan fenitoin.…”

Section: Pembahasanunclassified

Pemantauan Kadar Obat Indeks Terapi Sempit Melalui Estimasi Kadar Obat di Dalam Darah pada Pasien Rawat Inap di RSUD Prof. Dr. Margono Soekarjo, Purwokerto

Suryoputri

Mustikaningtias

Maharani

2020

ijcp

View full text Add to dashboard Cite

Pemantauan kadar obat dalam darah dapat dilakukan secara matematika dengan pendekatan farmakokinetik. Penelitian ini bertujuan untuk mengetahui estimasi kadar obat indeks terapi sempit di dalam darah sesuai dosis yang diberikan pada pasien rawat inap di rumah sakit. Pemantauan kadar obat dalam darah perlu dilakukan untuk menjamin tercapainya kadar obat yang cukup di tempat aksi/reseptor melalui aturan dosis yang diberikan, sehingga dapat mencegah timbulnya efek toksik dan mencapai clinical outcome pasien. Penelitian ini menggunakan metode rancangan observasional. Data mengenai dosis dan frekuensi pemberian obat diperoleh dari data rekam medik pasien, kemudian dilakukan perhitungan estimasi kadar tunak dalam darah (Css) dengan pendekatan secara farmakokinetik. Data diolah secara deskriptif analitik. Subjek penelitian adalah pasien rawat inap yang mendapatkan terapi aminofilin intravena (iv), fenitoin iv dan digoxin per oral (po) di Bangsal Paru, Saraf, dan Jantung (Penyakit Dalam) RSUD Prof Dr. Margono Soekardjo Purwokerto selama bulan Juni-Agustus 2019. Hasil penelitian ini menunjukkan bahwa pada estimasi kadar aminofilin di dalam darah, sebanyak 13 pasien (61,9%) berada di dalam rentang terapi (10-20 mg/L) dan 8 pasien (38,1%) di luar rentang terapi; pada estimasi kadar fenitoin di dalam darah, sebanyak 8 pasien (28,1%) berada di dalam rentang terapi (10-20 mg/L) dan 24 pasien (71,9%) berada di luar rentang terapi; dan pada estimasi kadar digoxin di dalam darah, sebanyak 4 pasien (11,8%) berada di dalam rentang terapi (0,50-0,90 ng/mL) dan 30 pasien (88,2%) berada di luar rentang terapi. Jumlah pasien yang memiliki estimasi kadar obat di dalam darah berada di dalam rentang terapi adalah 25 pasien (28,7%) dan jumlah pasien yang memiliki estimasi kadar obat di dalam darah berada di luar rentang terapi adalah 62 pasien (71,3%) sesuai dosis yang diberikan kepada pasien. Kadar obat di luar rentang terapi dikhawatirkan dapat menimbulkan kejadian toksisitas dan kemungkinan tidak dapat menghasilkan clinical outcome yang diinginkan.

show abstract

Machine Learning in High-Alert Medication Treatment: A Study on the Cardiovascular Drug

Tai

Sue

2020

Applied Sciences

View full text Add to dashboard Cite

The safety of high-alert medication treatment is still a challenge all over the world. Approximately one-half of adverse drug events (ADEs) are related to high-alert medications, which motivates us to improve the predicament faced in clinical practice. The purpose of this study is to use machine-learning techniques to predict the risk of high-alert medication treatment. Taking the cardiovascular drug digoxin as an example, we collected the records of 513 patients who received the pertinent therapy during hospitalization at a tertiary medical center in Taiwan. Considering serum digoxin concentration (SDC) is the primary indicator for assessing the risk of digoxin therapy, patients with SDC being controlled at the recommended range before their discharge were defined as a low-risk population; otherwise, patients were defined as the high-risk population. Weka 3.9.4—an open source machine learning software—was adopted to develop binary classification models to predict the risk of digoxin therapy by a number of machine-learning techniques, including k-nearest neighbors (kNN), decision tree (C4.5), support vector machine (SVM), random forest (RF), artificial neural network (ANN) and logistic regression (LGR). The results showed that the performance of RF was the best, followed by C4.5 and ANN; the remaining classifiers performed poorly. This study confirmed that machine-learning techniques can yield favorable prediction effectiveness for high-alert medication treatment, thereby decreasing the risk of ADEs and improving medication safety.

show abstract

Safety and Efficacy of Digoxin Therapy—Where Are We Now?

Cited by 3 publications

References 21 publications

Digoxin Holiday

Digoxin Holiday

Pemantauan Kadar Obat Indeks Terapi Sempit Melalui Estimasi Kadar Obat di Dalam Darah pada Pasien Rawat Inap di RSUD Prof. Dr. Margono Soekarjo, Purwokerto

Machine Learning in High-Alert Medication Treatment: A Study on the Cardiovascular Drug

Contact Info

Product

Resources

About