Assessment of the Appropriateness of Serum Digoxin Concentration Measurement in a Medical Group Setting

Orrico, Kathleen B.; Wu, Meng; Wilson, Ariane R

doi:10.18553/jmcp.2011.17.9.695

Cited by 12 publications

(20 citation statements)

References 8 publications

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“…The fact that valve diseases and rhythm disorders are more common in women (14) and that mortality occurs at a later age compared to men may cause digoxin use to appear relatively higher in women. The 1.8-fold higher rate in older women observed in our study compared to older men supports this theory and is in accordance with the results of many studies in the literature (12,(14)(15)(16)(17)(18).…”

Section: Discussionsupporting

confidence: 93%

Evaluation of Digoxin Levels in Elderly Patients in a Training Hospital: An 11-Year Follow-Up

Yılmaz¹,

Bilgili²,

Bozkaya³

2020

tjgeri

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Introduction: Digoxin monitoring is important in the elderly because of the toxicity risk. The aim of this study was to evaluate the orders made by different units for digoxin monitoring in the elderly. Materials and Method: Digoxin orders and results in patients aged over 65, patients' demographic characteristics, such as age and gender, the unit from which the order was made, and patients' pre-diagnoses were retrospectively recorded. Patients were divided into young-old, middle-old, and very-old groups, and the results were divided into subtherapeutic, therapeutic, and toxic levels. Results: The percentage of young-old, middle-old, and very-old patients was 39.4%, 45.3%, and 15.3%, respectively. Women were more (64.3%) and their median age and digoxin concentrations were higher (p<0.001). Outpatients' median digoxin concentrations were lower than inpatients' median digoxin concentrations (p<0.001). A proportion of 46.6% of all digoxin levels were therapeutic; 29.2% were subtherapeutic; and 24.2% were toxic. Subtherapeutic levels in males and toxic levels in females predominated (p<0.001). Toxic levels were higher in inpatients, and subtherapeutic levels were higher in outpatients (p<0.001). The highest rate of therapeutic levels was observed in young-old patients (48.7%), while toxic levels were observed most frequently in very-old patients (28.1%). The highest number of digoxin orders in elderly patients was from the emergency department (44.2%). Conclusion: In elderly patients, more than half of the serum digoxin orders were inappropriate. These results significantly changed according to gender, outpatient or inpatient status, age, and the ordering unit. Changes in digoxin pharmacokinetics, especially in the geriatric period, require physicians to be vigilant of subtherapeutic drug concentrations.

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Section: Discussionsupporting

confidence: 93%

Evaluation of Digoxin Levels in Elderly Patients in a Training Hospital: An 11-Year Follow-Up

Yılmaz¹,

Bilgili²,

Bozkaya³

2020

tjgeri

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“…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.…”

Section: Discussionmentioning

confidence: 96%

“…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%

Appropriateness of digoxin level monitoring in a childrens hospital

Huang¹,

Cao²,

Li³

2012

Afr. J. Pharm. Pharmacol.

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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.

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“…It has positive inotrope effects on heart muscles and the main indication of the drug is heart failure although it is not currently considered as the first line treatment (1). As therapeutic and toxic dosages of cardiac glycosides are almost identical, drug toxicity is common (2). Digoxin toxicity effects different parts of the body, such as the central nervous system with many side effects, such as headache, fatigue, dizziness and visual disturbances, digestive system such as nausea, vomiting, anorexia, and the cardiovascular system, such as arrhythmia (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Taking the Wrong Medication of Digoxin Tablets

2016

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Introduction: Although cardiac glycosides toxicity is common in patients taking these kinds of drugs, poisoning occurs rarely in healthy individuals. This case report describes a one-month duration of mistaken consumption of digoxin tablets in a patient that referred to the hospital with gastrointestinal poisoning manifestations. Case Presentation: The case was a 75-year-old female with a history of hypertension, hyperthyroidism, and digestive problems with common symptoms of gastrointestinal toxicity, nausea, and vomiting; mild digoxin toxicity was found rather than a simple gastrointestinal poisoning based on further investigations. Conclusions: Careful examination and EKG evaluation are essential to exclude drug toxicity in all patients referring to the hospital with gastrointestinal symptoms.

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Assessment of the Appropriateness of Serum Digoxin Concentration Measurement in a Medical Group Setting

Cited by 12 publications

References 8 publications

Evaluation of Digoxin Levels in Elderly Patients in a Training Hospital: An 11-Year Follow-Up

Evaluation of Digoxin Levels in Elderly Patients in a Training Hospital: An 11-Year Follow-Up

Appropriateness of digoxin level monitoring in a childrens hospital

Taking the Wrong Medication of Digoxin Tablets

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