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European Journal of Clinical Pharmacology

, Volume 16, Issue 4, pp 229–235 | Cite as

Can digoxin prescribing be improved? A comparison between intuitive and assisted dose selection

  • G. D. Johnston
  • D. W. G. Harron
  • D. G. McDevitt
Originals

Summary

37 patients on maintenance digoxin therapy were observed in hospital over an 8 day period. From day 1 to day 8 measurements of plasma digoxin and serum creatinine indicated that these patients were in the equilibrium state with regard to digoxin levels and renal function. Assuming a linear relationship between dose and plasma concentration, it was possible to calculate the doses which would have produced plasma concentrations of 1.5 ng/ml, and at the limits of the ‘usual therapeutic range’, 0.8 and 2.0 ng/ml. Doses obtained from six prescribing aids and those prescribed intuitively by the doctor were then compared. None of the methods used would have resulted in plasma digoxin concentrations within the ‘usual therapeutic range’ in more than 57% of the patients. The physicians' intuitive choice appeared to be better than the doses estimated from prescribing aids, in that they were correct as often as any assisted method, and when wrong tended to prescribe ‘too low’ rather than ‘too high’. The prescribing aids tended to overestimate dosage in many patients, as high as 65% with one. Plasma digoxin concentration measurement would appear to be the only way to ensure adequate therapeutic efficacy and avoid toxicity in patients receiving maintenance digoxin.

Key words

digoxin therapeutic range intuitive prescribing prescribing aid 

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References

  1. Aronson, J. K.: Monitoring digoxin therapy: 111. How useful are the nomograms? Br. J. Clin. Pharmacol.5, 55–64 (1978)Google Scholar
  2. Carruthers, S. G., Kelly, J. G., McDevitt, D. G.: Plasma digoxin concentrations in patients on admission to hospital. Br. Heart J.36, 707–712 (1974)Google Scholar
  3. Chamberlain, D. A., White, R. J., Howard, M. R., Smith, T. W.: Plasma digoxin concentrations in patients with atrial fibrillation. Br. Med. J.1970/III, 429–432Google Scholar
  4. Dobbs, S. M., Mawer, G. E., Rodgers, E. M., Woodcock, B. J., Lucas, S. B.: Can maintenance digoxin dose requirements be predicted? Br. J. Clin. Pharmacol.3, 231–237 (1976a)Google Scholar
  5. Dobbs, S. M., Parkes, J., Rodgers, E. M.: Digoxin: Linearity between dose and serum concentration. Br. J. Clin. Pharmacol.3, 940–941 (1976b)Google Scholar
  6. Dobbs, S. M., Nicholson, P. W., Rodgers, E. M., Mawer, G. E. and Kenyon, W. I.: Digoxin Prescribing: an evaluation of clinical judgement. Brit. Med. J.1978/II, 668–669Google Scholar
  7. Dobbs, S. M., Rodgers, E. M., Kenyon, W. I., Livshin, D., Slater, E., Godsmark, B.: Digoxin prescribing in perspective. Br. J. Clin. Pharmacol.4, 327–335 (1977)Google Scholar
  8. Doherty, J. E., Kane, J. J.: Clinical pharmacology of digitalis glycosides. Ann. Rev. Med. Greger, W. P., Coggins, C. H., Hancock, E. W., (eds.), pp. 159–171. Annual Reviews Inc. 1975Google Scholar
  9. Evered, D. C., and Chapman, C.: Plasma digoxin concentrations and digoxin toxicity in hospital patients. Br. Heart J.33, 540–545 (1971)Google Scholar
  10. Halkin, H., Sheiner, L. B., Peck, C. C., and Melmon, K. L.: Determinants of the renal clearance of digoxin. Clin. Pharmacol. Ther.17, 385–394 (1975)Google Scholar
  11. Jeliffe, R. W.: Factors to consider in planning digoxin therapy. J. Chronic Dis.24, 407–409 (1971)Google Scholar
  12. Jeliffe, R. W., Brooker, G.: A nomogram for digoxin therapy. Am. J. Med.57, 63–68 (1974)Google Scholar
  13. Johnston, G. D., Kelly, J. G., McDevitt, D. G.: Do patients take digoxin? Br. Heart J.40, 1–7 (1978)Google Scholar
  14. Johnston, G. D., McDevitt, D. G.: Variations of plasma digoxin concentrations in the equilibrium state after multiple dosing. Br. J. Clin. Pharmacol.5, 92–93 (1978a)Google Scholar
  15. Johnston, G. D., McDevitt, D. G.: Digoxin compliance in patients from general practice. Br. J. Clin. Pharmacol.6, 339–343 (1978b)Google Scholar
  16. Johnston, G. D., McDevitt, D. G.: Is maintenance digoxin necessary in patients with sinus rhythm? Lancet1979/I, 567–570Google Scholar
  17. Koup, J. R., Jusko, W. J., Elwood, C. M., Kohli, R. K.: Digoxin pharmacokinetics: Role of renal failure in dosage regimen design. Clin. Pharmacol. Ther.18, 9–21 (1975)Google Scholar
  18. McDevitt, D. G., Johnston, G. D.: Digitalis. Compliance as a factor in drug utilisation. In: Advances in pharmacology and therapeutics. Biochemical Clinical Pharmacology, Tillement, J. P. (ed.), Vol. 7, pp. 77–87. Oxford, New York: Pergamon Press 1978Google Scholar
  19. Manninen, V., Apajalahti, A., Melin, J., Karesoja, M.: Altered absorption of digoxin in patients given propantheline and metoclopramide. Lancet1973/I, 398–400Google Scholar
  20. Mawer, G. E.: Computer assisted prescribing of drugs. Clin. Pharmacokinet.1, 67–78 (1976)Google Scholar
  21. Mawer, G. E.: Unpublished observations (1974)Google Scholar
  22. Ojala, K., Karjalainen, J., Reissell, P.: Radioimmunoassay of digoxin. Lancet1972/I, 150Google Scholar
  23. Peck, C. C., Sheiner, L. B., Martin, C. M., Combs, D. T., Melmon, K. L.: Computer assisted digoxin therapy, N. Engl. J. Med.289, 441–446 (1973)Google Scholar
  24. Redfors, A.: Plasma digoxin concentration — its relation to digoxin dosage and clinical effects in patients with atrial fibrillation. Br. Heart J.34, 383–391 (1972)Google Scholar
  25. Saleh, A. H. K.: The uptake of digoxin and digitoxin by some antacids. J. Pharm. Pharmacol.26, 961–967 (1974)Google Scholar
  26. Siersback-Nielsen, K., Molholm Hansen, J., Kampmann, J., Kristensen, M.: Rapid evaluation of creatinine clearance. Lancet1971/I, 1133–1134Google Scholar
  27. Steiness, E.: Renal tubular secretion of digoxin. Circulation50, 103–107 (1974)Google Scholar
  28. Sumner, D. J., Russell, A. J., Whiting, B.: Digoxin pharmacokinetics: Multicompartmental analysis and its clinical implications. Br. J. Clin. Pharmacol.3, 221–229 (1976)Google Scholar
  29. Wagner, J. G., Yates, J. D., Willis, P. W., Sakmar, E., and Stoll, R. G.: Correlation of plasma levels of digoxin in cardiac patients with dose and measures of renal function. Clin. Pharmacol. Ther.15, 291–301 (1973)Google Scholar
  30. Whiting, B., Sumner, D. J., Goldberg, A.: An assessment of digoxin radioimmunoassay. Scott. Med. J.18, 69–74 (1973)Google Scholar

Copyright information

© Springer-Verlag 1979

Authors and Affiliations

  • G. D. Johnston
    • 1
  • D. W. G. Harron
    • 1
  • D. G. McDevitt
    • 1
  1. 1.Department of Therapeutics and Pharmacology and Department of PharmacyThe Queen's University of BelfastNorthern Ireland

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