Digoxin visual toxicity with therapeutic blood levels of digoxin

Wolin, Mitchell J.

doi:10.1016/s0002-9394(99)80161-5

Cited by 20 publications

(11 citation statements)

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“…Digoxin‐induced cone dysfunction has been reported in humans, rats and cats 11,26–32,36 . In this study, ERG examination confirmed that digoxin affects cone function in dogs.…”

Section: Discussionsupporting

confidence: 80%

“…Signs of digoxin toxicity include ventricular arrhythmia and atrioventricular block 34 . In humans, the most frequent side effect of digoxin is visual disturbance, including color vision disturbance, xanthopsia and diplopia 11,26–32,36 . The mechanism of visual disturbance is inhibition of the Na‐K channel in photoreceptor cells 11,27,30,36 .…”

Section: Discussionmentioning

confidence: 99%

“…We used digoxin (Digosin, Chugai, Tokyo, Japan), a cardiac glycoside that is used to treat congestive heart failure in small animals 33 . Digoxin‐induced cone dysfuction has been reported in humans and cats 26–32 . Digoxin was administered orally once daily for 14 days at a dose of 0.0125 mg/kg/day, which is within the recommended oral maintenance dosage range for dogs 34…”

Section: Methodsmentioning

confidence: 99%

“…We initially performed ERG using contact electrodes with a built‐in color light source (color LED‐electrode) in normal Beagle dogs. Next, we administered digoxin, which causes disorder of specific cone function in humans or cats, 26–32 and evaluated the effect on discrete cones by ERG using the color LED‐electrode. We herein discuss the clinical application of this method.…”

Section: Introductionmentioning

confidence: 99%

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Detection of cone dysfunction induced by digoxin in dogs by multicolor electroretinography

Maehara

Osawa

Itoh

et al. 2005

Veterinary Ophthalmology

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It is difficult to detect discrete cone function with the present conventional electroretinography (ERG) examination. In this study, we developed contact electrodes with a built-in color (red (644 nm), green (525 nm), or blue (470 nm)) light source (color LED-electrode), and evaluated an experimental model of digoxin in the dog. First, 17 normal Beagle dogs were used to determine which electrode works well for color ERG measurement on dogs. Then, color ERG was performed on seven normal Beagle dogs at various points during a 14-day period of digoxin administration. A single daily dose of 0.0125 mg/kg/day, which is within the recommended oral maintenance dosage range for dogs, was administered orally for 2 weeks. Ophthalmic examination, measurement of plasma concentration of digoxin, and color ERG examination were performed. On first examination, amplitudes of all responses were significantly (P < 0.01) lower with the red, than with the blue and green electrodes during ERG recording. In ERG using the red electrode, the standard deviation was large. According to these preliminary results, the red electrode was not used in the experimental dog model with digoxin. In the digoxin administrated animals, no significant change was observed in the ophthalmic examination findings. The digoxin level increased steadily throughout the dosing period but was always within the therapeutic range for dogs. In rod ERG, no abnormalities were detected with any electrode. In standard combined ERG, decreased amplitude of the a-wave was detected with every electrode. In single flash cone ERG, prolongation of implicit time was detected by color ERG with the blue and green electrodes. In 30-Hz flicker ERG, decreased amplitude was detected only by color ERG with the blue electrode. The decreased amplitude and prolonged implicit time recovered after termination of digoxin administration. Cone dysfunction induced by digoxin in the dog was revealed by multicolor ERG using blue and green LED-electrodes. Multi-color ERG was useful for detecting cone type-specific dysfunction in the dog.

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“…Digoxin‐induced cone dysfunction has been reported in humans, rats and cats 11,26–32,36 . In this study, ERG examination confirmed that digoxin affects cone function in dogs.…”

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Detection of cone dysfunction induced by digoxin in dogs by multicolor electroretinography

Maehara

Osawa

Itoh

et al. 2005

Veterinary Ophthalmology

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“…There have been several case reports in the literature of overt visual disturbance-for example, photopsia and reduced acuity, in patients with blood digitalis levels within the therapeutic range. [14][15][16] In all cases discontinuation of therapy was followed by complete resolution of symptoms. The reasons for the eye's susceptibility to the untoward effects of digitalis are not fully understood.…”

Section: Discussionmentioning

confidence: 99%

Acquired colour vision deficiency in patients receiving digoxin maintenance therapy

Lawrenson

Kelly

Lawrenson

et al. 2002

British Journal of Ophthalmology

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Background/aims: Disturbances of colour vision are a frequently reported sign of digoxin toxicity. The aim of this study was to investigate the incidence of acquired colour vision deficiency in elderly hospitalised patients receiving maintenance digoxin therapy. Methods: 30 patients (mean age 81.3 (SD 6.1) years) receiving digoxin were tested using a battery of colour vision tests (Ishihara, AO Hardy Rand Rittler plates, City tritan test, Lanthony tritan album, and the Farnsworth D15). These were compared to an age matched control group. Serum digoxin concentrations were determined from venous blood samples. Results: Slight to moderate red-green impairment was found in approximately 20-30% of patients taking digitalis, and approximately 20% showed a severe tritan deficiency. There was no correlation between colour vision impairment and serum digoxin level. Conclusions: Formal colour vision testing of elderly patients taking digitalis showed a high incidence of colour deficiency, suggesting that impairment of retinal function can occur even at therapeutic drug levels. As a result, colour vision testing in this population would have limited value for the detection of drug toxicity.

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Morgens beidseitige Visusminderung, abends kardiologische Intensivstation

Menke

Neppert

2008

Ophthalmologe

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Digoxin visual toxicity with therapeutic blood levels of digoxin

Cited by 20 publications

References 1 publication

Detection of cone dysfunction induced by digoxin in dogs by multicolor electroretinography

Detection of cone dysfunction induced by digoxin in dogs by multicolor electroretinography

Acquired colour vision deficiency in patients receiving digoxin maintenance therapy

Morgens beidseitige Visusminderung, abends kardiologische Intensivstation

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