Plasma digoxin concentrations and digoxin toxicity in hospital patients.

Evered, D.C.; Chapman, C. W.

doi:10.1136/hrt.33.4.540

Cited by 128 publications

(16 citation statements)

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“…Digoxin is one of the most prescribed drugs with advantages, including cost-effectiveness and well-tolerance, and the disadvantage of a mainly narrow therapeutic range [1],[3]. In studies performed in the 1970s, it was reported that 23% of patients on digoxin therapy were admitted to hospitals for digoxin intoxication [5]–[7]. Over the years digoxin intoxication rates reduced, as defined in Digitalis Investigation Group (DIG) study, and the hospitalization rate for digoxin intoxication was 2% [8]…”

Section: Discussionmentioning

confidence: 99%

Digoxin intoxication: An old enemy in modern era

Kırılmaz¹,

Saygı²,

Güngör³

et al. 2012

Journal of Geriatric Cardiology

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ObjectivesAlthough development of new treatment modalities limited digoxin usage, digoxin intoxication is still an important issue which could be easily overlooked. In this report, we analyzed a case series definitively diagnosed as digoxin intoxication in the modern era.MethodsWe analyzed 71 patients hospitalized with digoxin intoxication confirmed by history, complaints, clinical and electrocardiograph (ECG) findings, and serum digoxin levels > 2.0 ng/mL, during a five year period. The demographic and clinical data, indications for digoxin use, digoxin dosage, concurrent medications, laboratory data, hospital monitoring, and ECG findings were obtained from all patients.ResultsThirty-eight of 71 patients (53.5%) had symptoms of heart failure during admission or later. Sixty-four percent of patients were older than 75 years. The percentage of females was 67%. Atrial fibrillation, hypertension and gastrointestinal complaints were more frequent in the females (64% in females, 30% in males, P = 0.007; 81% in female, 52% in males, P = 0.01; 50% in female, 17.3% in males, P = 0.008, respectively). The mortality rate during the hospital course was 7%.ConclusionsThis report demonstrated the reduced mortality rates in patients with digoxin intoxication over the study period. Gastrointestinal complaints are the most common symptoms in this population.

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Section: Discussionmentioning

confidence: 99%

Digoxin intoxication: An old enemy in modern era

Kırılmaz¹,

Saygı²,

Güngör³

et al. 2012

Journal of Geriatric Cardiology

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“…Although digitalis toxicity is usually correlated with a high plasma concentration of the glycoside (Beller, Smith, Abelmann, Haber & Hood, 1971;Evered & Chapman, 1971;Carruthers, Kelly & MacDewitt, 1974), toxic effects may also occur in patients with normal therapeutic levels. This may be due to an increased myocardial sensitivity to the glycoside.…”

Section: Introductionmentioning

confidence: 99%

Digoxin Toxicity Compared With Myocardial Digoxin and Potassium Concentration

Steiness¹

1978

British J Pharmacology

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1 Twenty-nine dogs were given digoxin (0.25 mg) by mouth twice daily for eight days. Some of them (group 1) also received diuretics and others (group 2) a mineralocorticoid. The dogs were then given an intravenous bolus injection of digoxin and plasma and cardiac muscle were analysed for digoxin and potassium. 2 In the digitalized dogs, myocardial potassium concentration decreased following the intravenous injection of either 0.05 or 0.15 mg/kg digoxin; in contrast, in those dogs given diuretics or mineralocorticoid the potassium concentration increased. 3 Ventricular arrhythmias occurred after digoxin injection (0.05 mg/kg) in the hypokalemic dogs, in those given a mineralocortocoid and in those dogs which received a toxic digoxin dose (0.15 mg/kg). No arrhythmias where seen in the control (digitalized) group. 4 Myocardial digoxin concentrations were similar in the control digitalized group and in the mineralocorticoid-treated dogs after the intravenous administration of the lower digoxin dose (0.05 mg/kg). The myocardial digoxin concentration was significantly higher in the hypokalemic group and in the group receiving the higher digoxin dose (0.15 mg/kg). 5 There was no obvious relationship between the occurrence of arrhythmias and the myocardial concentration of digoxin or potassium.

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“…Unlike digoxin, the elimination of digitoxin is unaffected by alterations in renal function (Storstein, 1974) and there are no problems with bioavailability after oral dosing (Beerman, Hellstrom & Rosen, 1971;Shaw, Howard & Hamer, 1972). In addition an overall incidence of toxicity of 5.8% for digitoxin (Storstein et al, 1977) is considerably lower than the 21% for digoxin found by Evered & Chapman (1971). Since digitalis therapy is invaluable in certain conditions such as fast atrial fibrillation which is present in 2.5% of the population over 60 years (Kitchin, Lowther & Milne, 1973) and digoxin use in the elderly is often unsatisfactory, digitoxin may be a preferable choice.…”

Section: The Effect Of Age On Digitoxin Pharmacokineticsmentioning

confidence: 99%