Evaluation of Different Methods for Determining Serum Concentrations of Cardiac Glycosides
Two centuries have passed since Withering first reported that digitalis “has a power over the motion of the heart, to a degree yet unobserved in any other medicine” (Withering, 1937). Although digitalis glycosides are now widely used in the therapy of congestive heart failure, the dosage of digitalis preparations must, as in Withering’s day, be carefully adjusted to the needs of each individual patient in order that an optimal therapeutic effect may be achieved without the development of toxic side-effects because, as Withering noted, excessive digitalis “occasions sickness, vomiting. purging, giddiness, confused vision, objects appearing green or yellow ... slow pulse ... cold sweats, convulsions, syncope, death” (Withering, 1937). Developments in the first 6 decades of this Century which have enhanced the physician’s ability to adjust digitalis dosages to the specific needs of individual patients have included: the isolation of highly purified cardenolides, the recognition of the effects of digitalis on the electrocardiogram, a better definition of the effects of cardiac glycosides on myocardial contractility, conduction, and automaticity, and an appreciation of the role of electrolyte disturbances in facilitating the development of digitalis toxicity (Butler, 1972).
KeywordsCardiac Glycoside Serum Digoxin Concentration Digitalis Glycoside Competitive Protein Binding Tritiated Digoxin
Unable to display preview. Download preview PDF.
- Beiser, S.M., Butler, V.P., Jr., Erlanger, B.F.: Hapten-protein conjugates: methodology and application. In: Miescher, P.A., Müller-Eberhard, H.J. (eds.): Textbook of Immunopathology, 2nd ed. New York: Grune & Stratton 1976, p. 15Google Scholar
- Seiden, R., Smith, T.W.: Ouabain pharmacokinetics in dog and man: détermination by radioimmunoassay. Circulation 45,1176 (1972)Google Scholar
- Seiden, R., Klein, M.D., Smith, T.W.: Plasma concentration and urinary excrétion kinetics of acetyl strophanthidin. Circulation 47, 744 (1973)Google Scholar
- Shatzmann, H.J.: Herzglykoside als Hemmstoff für den aktiven Kalium- and Natriumtransport durch die Erythrocytenmembran. Helv. Physiol. Pharmacol. Acta 11, 346 (1953)Google Scholar
- Watson, E., Clark, D.R., Kalman, S.M.: Identification by gas chromatography-mass spectroscopy of dihydrodigoxin-a metabolite of digoxin in man. J. Pharmacol. Exp. Therap. 184, 424 (1973)Google Scholar
- Withering, W.: An account of the Foxglove and some of its medical uses: with practical remarks on dropsy and other diseases. Birmingham England, M. Swinney, 1785. Reprinted in Med. Classics 2, 295 (1937)Google Scholar