Studies of Digoxin Dosage, Kinetics and Serum Concentrations in Renal Failure and Review of the Literature

Gault, Henry; Jeffrey, John; Chirito, E.; Ward, Laurel L.

doi:10.1159/000180722

Cited by 45 publications

(17 citation statements)

References 41 publications

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“…In Figures 1 and 2 (1974), Dettli et al (1972) and Gault et al (1976)) would have resulted in the same plasma digoxin concentration and one (that of Jelliffe & Brooker (1974)) would have resulted in a plasma digoxin concentration of one-third of the observed value. Thus it is likely that the use of four of the methods described would have resulted in toxicity in one or both of those patients, toxicity probably more severe than was actually observed.…”

Section: Usefulness Of the Published Nomograms And Equationsmentioning

confidence: 88%

“…actual loading dose and calculated by the methods of Dettli et al (1972), Jelliffe & Brooker (1974) and Gault et al (1976). Both the lines of equality and the regression lines are shown.…”

Section: F the Plasma Digoxin Concentrations Which Wouldmentioning

confidence: 99%

“…Limitations ofthe nomograms Tozer (1974) and Gault et al (1976) have discussed the limitations of their own equations and nomograms and the limitations of nomograms for predicting other drug therapy have been discussed elsewhere (Richens & Dunlop, 1975;Hull & Sarubbi, 1976).…”

Section: Usefulness Of the Published Nomograms And Equationsmentioning

confidence: 99%

“…There is also evidence that the apparent Vd may be altered in the elderly (Ewy, Kapadia, Yao, Lullin & Marcus, 1969), in infants (Morselli, Assael, Gomeni, Mandelli, Marini, Reali, Visconti & Sereni, 1975) and in patients with thyroid disease (Doherty & Perkins, 1966). These wide variations in apparent Vd limit the usefulness of nomograms which are based upon initial loading dose estimations (as Jelliffe & Brooker's (1974)), upon subsequent maintenance dose estimations based on the initial loading dose (as Dettli et al (1972) andGault et al ( 1976) or even upon a priori maintenance dose estimations (as Dobbs et al (1976) and Sumner et al (1976)) since the eventual minimal steady-state concentration reached on repetitive dosing will depend on the apparent Vd (Wagner, 1975). Dettli et al (1972) in their equation description say that the apparent Vd was measured in their studies but take no account of it in developing their equation.…”

Section: Usefulness Of the Published Nomograms And Equationsmentioning

confidence: 99%

“…Several workers have published equations and nomograms intended to aid the physician in deciding on the most suitable digoxin dosage regimen for the individual patient (Dettli, Ohnhaus & Spring, 1972;Sheiner, Rosenberg & Melmon, 1972;Battig, Brune, Schmitt & Walz, 1974;Jelliffe & Brooker, 1974;Tozer, 1974;Dobbs, Mawer, Rodgers, Woodcock & Lucas, 1976;Sumner, Russell & Whiting, 1976; Gault, Jeffrey, Chirito & Ward, 1976).…”

Section: Introductionmentioning

confidence: 99%

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Monitoring digoxin therapy: III. How useful are the nomograms?

Aronson¹

1978

Brit J Clinical Pharma

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Section: Usefulness Of the Published Nomograms And Equationsmentioning

confidence: 88%

“…actual loading dose and calculated by the methods of Dettli et al (1972), Jelliffe & Brooker (1974) and Gault et al (1976). Both the lines of equality and the regression lines are shown.…”

Section: F the Plasma Digoxin Concentrations Which Wouldmentioning

confidence: 99%

Section: Usefulness Of the Published Nomograms And Equationsmentioning

confidence: 99%

Section: Usefulness Of the Published Nomograms And Equationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Monitoring digoxin therapy: III. How useful are the nomograms?

Aronson¹

1978

Brit J Clinical Pharma

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Evaluation of Various Methods of Digoxin Dosing

Jones

Perrier

Trinca

et al. 1982

The Journal of Clinical Pharma

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The ability to precisely predict serum digoxin concentrations using 12 published methods in a group of 85 patients was undertaken. Two methods of estimating creatinine clearance and two estimates of ideal body weight were employed as input variables using the 12 dosing methods. This resulted in 40 relationships from which correlation coefficients and linear regression constants were derived for predicted versus measured serum digoxin concentrations. The correlation coefficients between predicted and measured serum digoxin ranged from -0.393 to 0.389. Possible explanations for the low correlation coefficients are interpatient variability in the kinetics of digoxin, the small number of subjects used to generate some of the digoxin dosing methods, undetected patient noncompliance in the present study, the use of empirically derived dosing methods, and/or the use of rather homogeneous patient populations to develop a given method while this study is comprised of a heterogeneous group of patients. The methods studied tend to overpredict serum digoxin concentrations and therefore generally allow safe, first approximations for digoxin dosing.

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Pharmacokinetics of Beta‐Methyldigoxin in Subjects with Normal and Impaired Renal Function

Tsutsumi

Nakashima²,

Tateishi

et al. 1993

The Journal of Clinical Pharma

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Beta-methyldigoxin (beta-MD) was administered orally (0.2 mg) to 24 patients with various degrees of renal function, to investigate its pharmacokinetic characteristics related to renal function. Serum and urine collected until 120 hours after dosing were assayed for beta-MD and digoxin by high-performance liquid chromatography and fluorescence polarization immunoassay method. The steady-state volume of distribution decreased proportionately as creatinine clearance (CLCR) decreased, although steady-state volume of distribution of hemodialysis patients had large interindividual variability, and their mean value was not different from that of patients with normal renal function. Both renal clearance of beta-MD and digoxin were significantly correlated with CLCR (r = .820, P < .001 and r = .822, P < .01, respectively), and the slope of regression line for beta-MD was only 44% that for digoxin. Significantly reduced urinary excretion of total drug (beta-MD plus digoxin) was shown in patients with CLCR below 50 mL/minute/1.48 m2. This study suggests that the dosage modification is not necessary until CLCR decreases to below 50 mL/minute/1.48 m2, but careful attention should be given in the use of beta-MD in patients with CLCR below this value.

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Studies of Digoxin Dosage, Kinetics and Serum Concentrations in Renal Failure and Review of the Literature

Cited by 45 publications

References 41 publications

Monitoring digoxin therapy: III. How useful are the nomograms?

Monitoring digoxin therapy: III. How useful are the nomograms?

Evaluation of Various Methods of Digoxin Dosing

Pharmacokinetics of Beta‐Methyldigoxin in Subjects with Normal and Impaired Renal Function

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