Therapeutic Ranges of Serum Digoxin Concentrations in Patients With Heart Failure

Goldberger, Zachary D.; Goldberger, Ary L.

doi:10.1016/j.amjcard.2012.02.028

Cited by 69 publications

(46 citation statements)

References 39 publications

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“…Based on our results lower digoxin levels (0.5-1.2 ng/mL) are achieved in patients with HF than HF + AF indications what is an accordance with recommendations [29]. The safety and effectiveness of digoxin in elderly HF patients have been documented in a post-hoc analysis of the Digitalis Investigation Group trial [30].…”

Section: Discussionsupporting

confidence: 48%

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

Bajraktarevic¹

2016

JPP

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Abstract:The aim of our study was to determine the criteria and key factors for the effectiveness of digoxin therapy. A prospective opened-type study was carried out in conditions of everyday clinical practice. The concentrations of digoxin were quantified from blood samples taken following the achievement of drug steady-state (using AxSYM microparticle enzyme immunoassay-MEIA). The risk/benefit ratio was evaluated based upon the correlation between measured blood concentrations of the drug and clinical response. Study results (100 decompensated patients) revealed that therapy indication field was correctly covered, showing a higher prevalence in elderly. On average, each examinee had 2 or 3 comorbidities. Applied daily dose of digoxin ranged from 0.053 mg to 0.25 mg. Renal function was assessed by creatinine clearance which is one of the key factors for the accomplishment of optimal digoxin serum concentrations (p < 0.05). Co-administration of seven drugs was complicating factor for the management of rational therapy. 76/100 patients were within referent range (0.8-2.0 ng/mL), while 13/100 were above the upper limit. Four side effects in total were recorded (nausea, vomiting, confusion), whereas in only two patients digoxin was excluded from the therapy. Digoxin confirmed the justifiability of its use in contemporary clinical practice.

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Section: Discussionsupporting

confidence: 48%

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

Bajraktarevic¹

2016

JPP

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“…Furthermore, a post-hoc analyses of the DIG trial revealed that compared with SDCs ≥1 ng/mL, lower SDCs between 0.5 and 0.9 ng/mL were associated with significant decrease in all-cause mortality and hospitalisations in patients with HF 14. Importantly, the reference range varies across clinical laboratories, which has important implications for potential toxity 15 16. Hence, much more supportive evidence exists for use of lower SDCs between 0.5 and 1.0 ng/mL, and while a therapeutic range of 0.8–2.0 ng/mL is still often used in practice, the updated American College of Cardiology (ACC)/American Heart Association (AHA) guidelines actually recommend therapeutic range of 0.5–1.0 ng/mL 15…”

Section: Pharmacologymentioning

confidence: 99%

Digoxin: its role in contemporary medicine

Stucky

Goldberger

2015

Postgraduate Medical Journal

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Digoxin has been a key therapeutic for heart failure and atrial tachyarrhythmias for over 200 years following Withering's groundbreaking work depicting the therapeutic benefit of the common botanical foxglove in his 1785 monograph. The use of digoxin preceded any randomised evidence or even basic understanding of its mechanism of action. Over the past two decades, there has been mounting evidence further challenging the safety and efficacy of digoxin, while multiple other therapies for both heart failure and atrial tachyarrhythmias have proven to be more effective and safe. Altogether, digoxin still has an important role in contemporary pharmacotherapeutics, though its role remains controversial and should be reserved for selective patients and clinical situations, with careful attention to serum concentrations.

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“…One of the important limitations to digoxin use remains its narrow therapeutic index as it contributes to development of cardiac and non-cardiac (e.g., central nervous system, gastrointestinal) toxicities [8]. Understanding the current epidemiology of digoxin toxicity could provide additional context for renewed considerations of digoxin use in heart failure.…”

Section: Introductionmentioning

confidence: 99%

Emergency Department Visits and Hospitalizations for Digoxin Toxicity

See

Shehab

Kegler

et al. 2014

Circ: Heart Failure

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Background Recent data on digoxin prescribing and adverse events are lacking but could help inform the management of digoxin in contemporary heart failure treatment. Methods and Results We determined nationally-representative numbers and rates of emergency department (ED) visits for digoxin toxicity in the United States using 2005–2010 reports from the National Electronic Injury Surveillance System—Cooperative Adverse Drug Event Surveillance project and the National Ambulatory (and Hospital Ambulatory) Medical Care Surveys. Based on 441 cases, an estimated 5,156 (95% confidence interval [CI], 2,663–7,648) ED visits for digoxin toxicity occurred annually in the United States; over three-fourths (78.8% [95% CI, 73.5%–84.1%]) resulted in hospitalization. Serum digoxin level was ≥2.0 ng/mL for 95.8% (95% CI, 93.2%–98.4%) of estimated ED visits with levels reported (n=251 cases). The rate of ED visits per 10,000 outpatient prescription visits among patients ≥85 years was twice that of patients 40–84 years (rate ratio, 2.4 [95% CI, 1.2–5.0]); among females, the rate was twice that of males (rate ratio, 2.3 [95% CI, 1.1–4.7]). Digoxin toxicity accounted for an estimated 1.0% (95% CI, 0.6%–1.4%) of ED visits for all adverse drug events (ADEs) among patients ≥40 years, but an estimated 3.3% (95% CI, 2.3%–4.4%) of ED visits and 5.9% (95% CI, 4.0%–7.9%) of hospitalizations for all ADEs among patients ≥85 years. Estimated annual ED visits and hospitalizations remained relatively constant from 2005–2010. Conclusion Digoxin toxicity is not declining; more careful prescribing to high-risk groups and improved monitoring of serum levels might be needed to reduce morbidity from outpatient digoxin use.

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Therapeutic Ranges of Serum Digoxin Concentrations in Patients With Heart Failure

Cited by 69 publications

References 39 publications

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

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

Digoxin: its role in contemporary medicine

Emergency Department Visits and Hospitalizations for Digoxin Toxicity

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