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.
References
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: 491–495
Vozeh S (1987) Therapeutic drug monitoring of digoxin. Eur J Clin Pharmacol 33: 107–108
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: 635–642
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: 319–333
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: 611–614
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: 13–18
Siersbaek-Nielsen K, Molholm-Hansen J, Kampmann J, Kristensen M (1971) Rapid evaluation of creatinine clearance. Lancet 1: 1133–1134
Aronson JK, Grahame-Smith DG, Wigley FM (1978) Monitoring digoxin therapy. Quart J Med NS47: 111–122
SAS User's Guide: Statistics (1982) SAS Institute Inc., Cary, NC
Aronson JK (1983) Indications for the measurement of plasma digoxin concentrations. Drugs 26: 230–242
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 77–88
Larbig D, Haasis R, Kochsiek K (1978) The glycoside concentration and its clinical significance. Forum Cardiologicum 15, Boehringer Mannheim Study Monograph Series, Mannheim, FRG
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: 231–236
Johnston GD, Kelly JG, McDevitt DG (1978) Do patients take digoxin? Br Heart J 40: 1–7
Taggart AJ, Johnston GD, McDevitt DG (1981) Does frequency of daily dosage influence compliance with digoxin therapy? Br J Clin Pharmacol 1: 31–34
Boston Collaborative Drug Surveillance Program (1972) Relation between digoxin arrhythmia and ABO blood groups. Circulation 45: 352–357
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: 989–997
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: 319–329
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: 1089–1091
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Seghieri, G., Bartolomei, G.C., De Giorgio, L.A. et al. Serum digoxin and beta-methyldigoxin in elderly patients on hospital admission: correlation with home compliance and clinical variables. Eur J Clin Pharmacol 37, 401–404 (1989). https://doi.org/10.1007/BF00558509
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00558509