How to digitalize and to maintain optimal digoxin levels in cogestive heart failure

Abstract

Due to the narrow therapeutic-to-toxic ratio of digoxin, numerous studies have been done to assess the optimal digoxin level in patients with congestive heart failure. A digoxin level of 0.7-1.5 ng/mL (or 0.9-2.0 nMol/L) is generally considered optimal, but even at these levels toxicity may occur in certain clinical situations such as severe pulmonary disease or when electrolyte or metabolic disturbances are present. The optimal daily maintenance dose of digoxin depends on the preparation given and can be calculated by the equation of Jelliffe, which is largely based on the creatinine clearance of the patient. The daily digoxin dose must also be adjusted to take into consideration disease processes or concomitant drug therapy that can alter the volume of distribution, the biotransformation, or the excretion of the drug.

New Trends in Sustainable Development for Industry 5.0: Digital Green Innovation Economy

“…Consequently, this shift in economic dynamics can drive the emergence and development of innovative economic sectors and formats, ultimately enhancing the ability to achieve sustainable economic growth and changing the overall mode of economic development. (Lambert & Rouleau, 1989).…”

Pharmacological considerations in digoxin therapy

“…The optimal daily maintenance dose of digoxin depends on the preparation administered and can be calculated by the equation of Jelliffe, which is largely based on the creatinine clearance of the patient. 5 The daily dose must then be adjusted to take into consideration different diseases, any alterations in plasma electrolytes, metabolic disturbances or concomitant drug therapy that can alter digoxin's volume of distribution, its biotransformation or excretion (Box).…”

Intermittent low-dose digoxin may be effective and safe in patients with chronic heart failure undergoing maintenance hemodialysis

“…Digoxin is one of the most commonly prescribed drugs for the treatment of CHF but, as a substantial fraction of the absorbed dose is cleared by the kidneys, its toxicity is often the result of an impaired renal function (1). Digoxin has a small therapeutic-to-toxic margin in patients with CHF (2), particularly in those patients who often have renal dysfunction, and it is therefore logical that, in recent years, numerous physicians have stopped using digoxin for the treatment of patients with CHF on hemodialysis.…”