Treatment of Digoxin Intoxication

Härtel, Gottfried; Manninen, Vesa; Reissell, Pentti

doi:10.1016/s0140-6736(73)93111-5

Cited by 28 publications

(4 citation statements)

References 10 publications

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“…Thus the possibilities for charcoal to adsorb digitalis glycosides to a clinically important extent seem to be good. Hartel et al (1973) gave 0.5mg of digoxin to 6 healthy volunteers in a crossover manner either without activated charcoal or with 2g given as a water suspension 5 minutes after the drug. Even this small amount of charcoal reduced peak serum digoxin concentrations and the AUC0-6h by about 65%.…”

Section: Digitalis Glycosidesmentioning

confidence: 99%

Clinical Pharmacokinetics of Oral Activated Charcoal in Acute Intoxications

Neuvonen

1982

Clinical Pharmacokinetics

152

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Activated charcoal has the ability to adsorb a wide variety of substances onto its sUrface. This property can be applied in preventing the absorption of various drugs and toxins from the gastrointestinal tract and in some cases to increase their rate of elimination. In vitro. the extent of adsorption depends mainly on the relative amounts oj the charcoal and the drug ingested. but the quality and formulation of the activated charcoal. as well as other Jactors such as the pH of the incubation medium also have an effect. Under optimum conditions the adsorption to charcoal is a rapid process but desorption from charcoal is possible due. for example. to competition by other substances or to changes in pH.In acute poisonings the most important determinants of the efficacy oj activated charcoal are the delay in the administration and the amount of activated charcoal given. Activated charcoal should be given as a water suspension as soon as possible. preferably within 30 minutes oJthe ingestion of the toxic agent. However. in acute intoxications the absorption of drugs may be considerably delayed and thus charcoal may be effective when administered 24 hours after drug ingestion. At a constant charcoal-drug ratio. the adsorption capacity oj charcoal increases with increasing doses because the competitive effect of gastrointestinal contents diminishes. Thus the amount oj charcoal should be as high as feasible. i.e. about 50 to lOOg in adults. This amount is able to adsorb lethal doses of many drugs. Significant desorption from charcoal and subsequent systemic absorption of a drug is possible if inadequate amounts of charcoal are used. The adsorption to charcoal is more complete in poisonings with potent drugs. i.e. where the charcoal-drug ratio is high (e.g. digitalis glycosides. tricyclic antidepressants. etc.). With some drugs the adsorption capacity may be exceeded, e.g. in aspirin poisonings, but even in these cases the charcoal may adsorb that fraction oj the drug which is dissolved in the gastrointestinal./luids.In experimental studies. the efficacy of charcoal in preventing systemic absorption oj many drugs has been of the same order or even better than that of emesis, but in certain poisonings the efficacy oj charcoal is inadequate, e.g. in those caused by ethanol, methanol or iron salts. Charcoal is rather ineffective and may even be contraindicated in poisonings caused by caustic alkalis or acids. Charcoal is non-toxic but, if administered too rapidly, patients may vomit.Some drugs and toxic agents have a long elimination half-life and are excreted into the gastrointestinal tract and then reabsorbed. With such agents multiple oral doses of activated charcoal, e.g. 20g every 6 hours Jor 1 or 2 days, can accelerate their elimination and shorten the duration of intoxication.

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Section: Digitalis Glycosidesmentioning

confidence: 99%

Clinical Pharmacokinetics of Oral Activated Charcoal in Acute Intoxications

Neuvonen

1982

Clinical Pharmacokinetics

152

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“…These investigators also demonstrated a nearly 30% reduction in steady-state plasma digoxin concentration after 12 days of activated charcoal therapy administered 12 hours prior to and 4 hours after digoxin doses. The latter interaction seems more likely to be attributable to interference with the enterohepatic circulation of digoxin than to reduced absorption, and may account for the efficacy of activated char-231 coal in the treatment of digoxin intoxication (Hartel et al 1973). …”

Section: Activated Charcoalmentioning

confidence: 99%

Pharmacokinetic Interactions with Digoxin

Rodin

Johnson

1988

Clinical Pharmacokinetics

100

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Numerous pharmacological agents have been shown to produce clinically significant pharmacokinetic interactions with digoxin. Drugs which reduce digoxin absorption include the antacids aluminium hydroxide, magnesium hydroxide and magnesium trisilicate, the antidiarrhoeals kaolin and pectin, the hypocholesterolaemic agent cholestyramine and the chemotoxins cyclophosphamide, vincristine and bleomycin. Certain antibiotics including sulphasalazine, neomycin and aminosalicylic acid reduce digoxin absorption while others, including erythromycin and tetracycline, increase the bioavailability of digoxin in some patients. Capsule preparations of digoxin in solution are less subject to several of the interactions which affect the absorption and bioavailability of digoxin tablets. Various drugs induce alterations in the volume of distribution and clearance of digoxin. Cardiac patients receiving digoxin therapy are particularly prone to interactions with commonly co-administered medications such as the antiarrhythmics quinidine and amiodarone, the calcium channel blockers verapamil and nifedipine, and possibly some vasodilating agents. Studies of digoxin interactions have yielded discrepant results, indicating the need for careful analysis of investigational design before arriving at clinical conclusions.

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“…Administration of activated charcoal effectively decreases the absorption of digoxin (1,2). However, the literature on the effect of fibre on digoxin absorption yields conflicting results (3-5).…”

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confidence: 99%

Effect of Administration of Activated Charcoal and Fibre on Absorption, Excretion and Steady State Blood Levels of Digoxin and Digitoxin. Evidence for Intestinal Secretion of the Glycosides

Reissell

Manninen

1982

Journal of Internal Medicine

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ABSTRACT. The effects of activated charcoal and fibre on absorption and stationary plasma levels of digoxin and digitoxin have been studied. The effect of fibre alone is small but an interactive effect on absorption may occur if fibre and digoxin are ingested simultaneously. Charcoal effectively decreases glycoside absorption even when administered after the glycosides. During maintenance therapy with digoxin or digitoxin, charcoal administration decreased the glycoside plasma levels by 31.2% and 18.3% respectively. It is suggested that even digoxin may have a significant biliary excretion and enterohepatic circulation or that this glycoside has a significant intestinal secretion. The therapeutic implication of this study is that charcoal may be of value, not only in the management of acute glycoside poisoning, but also in some cases of more chronic intoxication.

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Treatment of Digoxin Intoxication

Cited by 28 publications

References 10 publications

Clinical Pharmacokinetics of Oral Activated Charcoal in Acute Intoxications

Clinical Pharmacokinetics of Oral Activated Charcoal in Acute Intoxications

Pharmacokinetic Interactions with Digoxin

Effect of Administration of Activated Charcoal and Fibre on Absorption, Excretion and Steady State Blood Levels of Digoxin and Digitoxin. Evidence for Intestinal Secretion of the Glycosides

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