TDM of digoxin in clinical practice

Czech version

Authors: M. Grundmann ¹; I. Kacířová ^1,2
Authors‘ workplace: Ústav klinické farmakologie, LF OU, Ostrava ¹; Oddělení klinické farmakologie, Ústav laboratorní dia gnostiky, FN Ostrava ²
Published in: Kardiol Rev Int Med 2015, 17(1): 65-69
Category: Internal Medicine

Overview

Introduction:
Digoxin is a positive inotropic drug frequently prescribed in the treatment of chronic congestive cardiac failure. Recent evidence suggests that a lower therapeutic range of 0.5– 0.9 ng/ mL is associated with reduced mortality. With complex pharmacokinetic profile and narrow therapeutic index, its use in managing patients with heart failure can present a challenge to clinicians.

Aim:
To show the advantages of therapeutic drug monitoring for dosing of digoxin.

Method:
Bayesian analysis was used to predict the long‑term serum concentration – time profiles of digoxin, using the MW‑ Pharm 3.30 software. The serum levels of digoxin were determined by MEIA.

Results:
Three case reports are presented showing a prediction of steady‑ state digoxin level three days after the start of administration, drug‑drug interaction between digoxin and spironolactone/ carvedilol and an example of long‑term patient non‑compliance.

Conclusion:
Therapeutic drug monitoring is very useful for prediction of serum levels of digoxin alone and in combination with different interacting drugs. It helps to understand compliance‑ influencing factors and to improve interventional strategies to increase digoxin compliance.

Keywords:
chronic heart failure – digoxin – therapeutic drug monitoring – compliance – drug‑drug interactions

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