Advertisement

European Journal of Clinical Pharmacology

, Volume 37, Issue 4, pp 401–404 | Cite as

Serum digoxin and beta-methyldigoxin in elderly patients on hospital admission: correlation with home compliance and clinical variables

  • G. Seghieri
  • G. C. Bartolomei
  • L. A. De Giorgio
  • F. Innocenti
  • A. Gironi
  • M. Mian
  • F. Franconi
Short Communications

Summary

Serum digoxin and beta-methyldigoxin (BMD) were measured in 165 elderly patients (age >60 years) admitted to hospital, of whom 109 had been treated at home with digoxin and 56 with BMD.

The mean BMD level was significantly lower than that of digoxin (1.1 vs. 1.4 ng/ml). Creatinine clearance and daily dose were the variables most strongly associated with digoxin level, and the prescribed dose and serum albumin were the best predictors of the BMD concentration. Compliance was assessed by a compliance index (CI), namely the ratio of the measured glycoside concentration, corrected for creatinine clearance, over the expected steady-state dose, calculated from a hospitalized reference group. Compliant individuals in both treatment groups, i.e. those with a CI > the median value, were characterized by a lower daily dose and dosage frequency.

Toxicity, whether clinical or electrocardiographic, was present in 9% of the patients and was associated only with a significantly higher mean serum level of the drug.

Key words

digoxin beta-methyldigoxin serum levels compliance toxicity elderly patients hospital admission prediction 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Dobbs RJ, Nicholson PW, Denham MJ, Dobbs SM, O'Neill CJA (1986) Therapeutic drug monitoring of digoxin: Help or hindrance? Eur J Clin Pharmacol 31: 491–495Google Scholar
  2. 2.
    Vozeh S (1987) Therapeutic drug monitoring of digoxin. Eur J Clin Pharmacol 33: 107–108Google Scholar
  3. 3.
    Berman W, Ravenscroft P, Scheiner L, Heymann M, Melmon M, Rudolf A (1977) Differential effects of digoxin in tissues of foetal and adult sheep. Circ Res 41: 635–642Google Scholar
  4. 4.
    Marsh LA, Lloyd B, Taylor R (1981) Age dependence of myocardial Na-K ATPase activity and digitalis intoxication in the dog and guinea pig. Circ Res 48: 319–333Google Scholar
  5. 5.
    Dobbs RJ, Royston JP, O'Neill CJA, Deshmukh AA, Nicholson PW, Denham MJ, Dobbs SM (1987) Prescribing digoxin in geriatric units: The unexplained variability in dosage requirements. Eur J Pharmacol 32: 611–614Google Scholar
  6. 6.
    Gironi A, Seghieri G, De Giorgio LA, Gori D, Bartolomei GC (1981) Serum cardiac glycosides determination by enzyme-linked immunosorbent assay ELISA. J Res Lab Med 8: 13–18Google Scholar
  7. 7.
    Siersbaek-Nielsen K, Molholm-Hansen J, Kampmann J, Kristensen M (1971) Rapid evaluation of creatinine clearance. Lancet 1: 1133–1134Google Scholar
  8. 8.
    Aronson JK, Grahame-Smith DG, Wigley FM (1978) Monitoring digoxin therapy. Quart J Med NS47: 111–122Google Scholar
  9. 9.
    SAS User's Guide: Statistics (1982) SAS Institute Inc., Cary, NCGoogle Scholar
  10. 10.
    Aronson JK (1983) Indications for the measurement of plasma digoxin concentrations. Drugs 26: 230–242Google Scholar
  11. 11.
    Larbig D (1983) Renal excretion of cardiac glycosides. In: Ambrosioni E, Carbonin PU (eds) Bioavailability and metabolism of cardiac glycosides. Bioscience Ediprint Inc., Geneva, pp 77–88Google Scholar
  12. 12.
    Larbig D, Haasis R, Kochsiek K (1978) The glycoside concentration and its clinical significance. Forum Cardiologicum 15, Boehringer Mannheim Study Monograph Series, Mannheim, FRGGoogle Scholar
  13. 13.
    Johnson BF, Bye CE, Jones GE, Sabey GA (1976) The pharmacokinetics of β-methyldigoxin compared with digoxin tablets and capsules. Eur J Clin Pharmacol 10: 231–236Google Scholar
  14. 14.
    Johnston GD, Kelly JG, McDevitt DG (1978) Do patients take digoxin? Br Heart J 40: 1–7Google Scholar
  15. 15.
    Taggart AJ, Johnston GD, McDevitt DG (1981) Does frequency of daily dosage influence compliance with digoxin therapy? Br J Clin Pharmacol 1: 31–34Google Scholar
  16. 16.
    Boston Collaborative Drug Surveillance Program (1972) Relation between digoxin arrhythmia and ABO blood groups. Circulation 45: 352–357Google Scholar
  17. 17.
    Beller GA, Smith TW, Abelmann WH, Haber E, Hood WB Jr (1971) Digitalis intoxication. A prospective clinical study with serum level correlations. N Engl J Med 284: 989–997Google Scholar
  18. 18.
    Bernabei R, Perna GP, Carosella L, Di Nardo P, Cocchi A, Weisz AM, Carbonin PU (1980) Digoxin serum concentration measurement in patients with suspected digitalis-induced arrhythmias. J Cardiovasc Pharmacol 2: 319–329Google Scholar
  19. 19.
    Sonnenblick M, Abraham AS, Meshulam Z, Eylath U (1983) Correlation between manifestations of digoxin toxicity and serum digoxin, calcium, potassium, and magnesium concentrations and arterial pH. Br Med J 286: 1089–1091Google Scholar

Copyright information

© Springer-Verlag 1989

Authors and Affiliations

  • G. Seghieri
    • 1
  • G. C. Bartolomei
    • 1
  • L. A. De Giorgio
    • 1
  • F. Innocenti
    • 1
  • A. Gironi
    • 2
  • M. Mian
    • 3
  • F. Franconi
    • 4
  1. 1.Second Division of Internal MedicinePistoiaItaly
  2. 2.Department of Clinical ChemistrySpedali RiunitiPistoiaItaly
  3. 3.Institute of PharmacologyUniversity of PisaPisaItaly
  4. 4.Institute of BiochemistryUniversity of SassariSassariItaly

Personalised recommendations