Digoxin, sold under the brand name lanoxin among others, is a medication used to treat various heart conditions. The book ends with sections on toxicity and prescribing practice. Special populations, physiological conditions and pharmacogenomics focuses on critical issues in therapeutic drug monitoring including special requirements of therapeutic drug monitoring important to special populations infants and children, pregnant women, elderly patients, and obese. The relationship between digoxin plasma concentration and its therapeutic and toxic effects is described, various factors that may affect the pharmacokinetics of digoxin and interindividual sensitivity to the drug are summarized, and the use of plasma concentrations in determining dosage levels is discussed. The neurohormonal effects of digoxin include improved baroreceptor sensitivity, decreased norepinephrine concentration, decreased reninangiotensin activations, sympathoinhibitory effect, and increase release of atrial natriuretic peptide and brain. Digoxin may also be considered for svt without hydrops or ventricular dysfunction if heart rate is. However, clinical unmet need remains with up to a third of patients commenced on a biologic therapy having minimal or no response. Digoxin has a distinct distribution phase, which lasts 68 hours and thus its disposition is best described by a twocompartment pharmacokinetic model. Students like that each chapter includes sample problems throughout the chapter, with a ton of practice problems at the end. In the acute care setting, historically digoxin loading doses of 1 mg70 kg were administered. Digoxin is used in several cardiac pathologies such as atrial fibrillation and heart failure.
Clinical pharmacokinetics digoxin jean nappi, pharm. Thank you for giving me that opportunuity to present to you today. Common side effects include breast enlargement with other side effects generally due to an. Pharmacokinetic considerations for digoxin in older people. Since pharmacists are often leading pharmacokinetic dosing services in clinical practice, this would also be a valuable reference for clinicians hoping to hone those skills. Digoxin remains a widely used pharmacologic agent in clinical practice, and is often prescribed among the elderly patients. The pharmaceutical journal 9 aug 2017 by laurence a. All the basic concepts of pharmacokinetics pks are described, with an emphasis on understanding what parameters such as bioavailability, volume of distribution and clearance tell us about the behaviour of a particular drug. Introduction to pharmacokinetics and pharmacodynamics. The degree of binding to serum albumin is 20 to 30%. Digoxin is roughly 30 percent protein bound in the plasma and has a large volume of distribution vd of nearly 7 lkg in healthy adults.
Most frequently it is used for atrial fibrillation, atrial flutter, and heart failure. Clinical pharmacokinetics of therapeutic monoclonal. Determining digoxin pharmacokinetics by fluorescence polarization immunoassay. It is these effects that allow it to be used for atrial fibrillation. Finally, rifampin, an antibiotic used in the treatment of tuberculosis, may lower steady state serum digoxin. Clinical pharmacokinetics and anticoagulation service guidelines pdf, 1. About 70 to 80% of an oral dose of digoxin is absorbed, mainly in the. Cv pharmacology cardiac glycosides digitalis compounds. It is incompletely absorbed and once absorbed, a substantial fraction is cleared by the kidneys. Pharmacokinetics is the study of the process of drug absorption, distribution, metabolism and elimination. Listing a study does not mean it has been evaluated by the u.
Pharmacokinetics and safety profile of digoxin in infants with single ventricle congenital heart disease dgx01 the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Applying pharmacokinetics to clinical practice books. If you continue browsing the site, you agree to the use of cookies on this website. Reliable information about the coronavirus covid19 is available from the world health organization current situation, international travel. Jul 01, 2014 good morning class, iam youan bi beniet marius and im speaking to you as a master student of clinical pharmacy. Clinical pharmacokinetics of digitoxin springerlink. Editorial project manager, books and elearning courses. Dec, 2012 the pharmacodynamic effects of digoxin, including toxic symptoms, are correlated with the uptake of digoxin in the heart after a single dose and with the steady state serum digoxin concentration during maintenance therapy. Discuss how renal dysfunction affects loading and maintenance doses of digoxin. Pdf pharmacokinetic considerations for digoxin in older. Clinical correlate digoxin, particularly when given intravenously, is an example of a drug that is well described by twocompartment pharmacokinetics. References evidencebased clinical decision support at. Basic clinical pharmacokinetics was designed to simplify pharmacokinetics to help pharmacy students in clinical settings and busy practitioners understand and visualize basic principles. The most current, handson book in the field, applied clinical pharmacokinetics the perfect textbook for pharmacy students learning the clinical application of pharmacokinetics, which is the mathematical tools for modifying doages.
Pk is an important tool when conducting both basic and applied research and is an essential component of the drug development process. Applied clinical pharmacokinetics 3e kindle edition by. Pharmacokinetic design of digoxin dosage regimens in relation to renal function. The physiological approach adopted in the book allows clinical issues in drug therapy to be addressed, making it directly applicable to. Digoxin casebook in clinical pharmacokinetics and drug dosing. Pharmaceutical services division ministry of health malaysia. This clinical pharmacokinetics pharmacy handbook serves as a guide for the pharmacists. If the half life of digoxin is 36 hours, approximately 7 days 112 days x 5 halflives are required to achieve a new.
Clinical pharmacokinetics of digitalis glycosides sciencedirect. Medical books concepts in clinical pharmacokinetics. Patients with serum drug concentrations on noncovered services are identified on a daily basis utilizing sunrise clinical manager scm. Pharmacokinetics and clinical pharmacology series title handbook of experimental pharmacology series volume 56 2.
Digoxin casebook in clinical pharmacokinetics and drug. Dec, 2012 the disposition kinetics of digitoxin have not been as thoroughly examined as those of digoxin. Impaired kidney function is the most important condition with an influence on the pharmacokinetics of digoxin. In addition to the above list uk healthcare pharmacy services has guidelines for heparin induced thrombocytopenia hit and the assessment and management of venous thromboembolism vte prophylaxis. Practitioners involved in monitoring digoxin use need to maintain a high level of suspicion for digoxin toxicity. Pharmacokinetic and pharmacodynamic interaction study of. As expected, when measured by peak serum digoxin concentration as well as by area under the serum digoxin concentrationtime curve the bioavailability of digoxin appeared to be higher in the fasting. N2 the disposition kinetics of digitoxin have not been as thoroughly examined as those of digoxin. This book was originally written to help practitioners predict drug doses to achieve target drug concentrations from doses administered to patients. Digoxin is a medication that comes from the leaves of the digitalis plant. Digoxin toxicity can be a lifethreatening condition. Pharmacokinetics and safety profile of digoxin in infants. One pharmacokinetic study measured the mean body clearance of.
Large intersubject variations in the serum digoxin concentration profiles were observed. Principles of therapeutic drug monitoring article pdf available in american journal of pharmaceutical education 706 january 1992 with 2,635 reads how we measure. The physiological approach adopted in the book allows clinical issues in drug therapy to. These are the sources and citations used to research digoxin toxicity. Aging is an ongoing process that culminates in structural and functional changes in older populations and these changes have marked affects on. Role of renal failure in dosage regimen design jeffrey r. Clinical pharmacokinetics an overview sciencedirect topics. Digoxin pharmacokinetics in the elderly springerlink. The long halflife of digitalis compounds necessitates special considerations when dosing. Digoxin is used for the treatment of congestive heart failure chf because of its inotropic effects on the myocardium and for the treatment of atrial fibrillation because of its chronotropic effects on the electrophysiological system of the heart. The pharmacokinetics of digitalis glycosides have been the subject of extensive re view iisalo, 1977.
Digoxin has a large volume of distribution, due to its high affinity for skeletal and cardiac muscles, intestines and kidney. The use of pharmacokinetics to adjust the dosing regimen can reduce the incidence of digoxin toxicity. The rate at which a new digoxin steady state is achieved is dependent on the digoxin elimination halflife. Research on glycoside kinetics has progressed at a rapid pace, requiring continuing reevaluation of the state of our understanding of this problem. In adults with heart failure, when it is clinically possible, digoxin should be. About 70 to 80% of an oral dose of digoxin is absorbed, mainly in the proximal part of the small intestine. Digoxin pharmacokinetics and perindopril in heart failure. Find information on digoxin lanoxin in daviss drug guide including dosage, side effects, interactions, nursing implications, mechanism of action, half life, administration, and more. The past four editions of concepts in clinical pharmacokinetics have helped simplify a complex subject for thousands of pharmacy students and practitioners. Oct 05, 2000 pharmacokinetic and pharmacodynamic interaction study of digoxin and hawthorn the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Casebook in clinical pharmacokinetics and drug dosing. Describe the bloavailability, volume of distribution, protein binding, elimination pathways and clinical effects of digoxin.
Darren m roberts, 1, 2, 3 emma southcott, 4 julia m potter, 2, 4 michael s roberts, 5 michael eddleston, 1, 3, 6 and nick a buckley 1, 2, 3. In 1993, the proved 9 and radiance 10 trials were published, which showed improvement in surrogate endpoints for heart failure. Jul 15, 2015 the book could be used as a required text or supplement for a pharmacokinetics course, as there are many practice problems that are easy to follow. Plasma digoxin concentrationits relation to digoxin dosage and clinical effects in patients with atrial fibrillation. Patients with serum drug concentrations on noncovered services are identified on a daily basis utilizing sunrise clinical. Digoxin is used for the treatment of congestive heart failure chf because of its inotropic effects on the. The first half of this thoroughly updated book discusses pharmacokinetic concepts and presents clinical examples and practice questions after each chapter, while the second half applies the pharmacokinetic concepts in chapters on the most commonly dosed drugs in clinical practice. Digoxin dosing should be based on ideal body weight. Special article clinical pharmacokinetics of digitalis glycosides james e. Clinical pharmacokinetics pharmacy handbook second edition. Clinical pharmacokinetics service along with pharmacy practice residents and py4 pharmacy students as part of a residentstudent rotation in clinical pharmacokinetics.
This chapter discusses various aspects of clinical pharmacokinetics pk. Pharmacokinetic interactions between digoxin and other drugs. Concepts in clinical pharmacokinetics medical books. The bioavailability of digoxin varies depending on dosage form. Oclcs webjunction has pulled together information and resources to assist library staff as they consider how to handle coronavirus. Digoxin is extensively distributed in the tissues, as reflected by the large volume of distribution.
An easytoread, casestudy format has made the text a favorite among students, clinical. Considerations for use from the atrial fibrillation. Role of pharmacokinetics in drug dosage adjustment. Clinical pharmacokinetics is the application of pharmacokinetic principles to the safe and effective therapeutic management of drugs in an individual patient. Digoxin is taken by mouth or by injection into a vein common side effects include breast enlargement with other side effects generally due to an excessive dose. This includes the ability to recognize toxicity regardless of whether digoxin concentrations fall within the therapeutic range. At the same time, digoxin has a negative chronotropic effect that decreases heart rate by its influence on the cardiac electrical conduction pathway. Winter digoxin is an inotropic agent primarily used to treat congestive heart failure chf and atrial. Clinical pharmacokinetics pharmacokinetics adme and digoxin case study slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Digitoxin appears to be rapidly and completely absorbed after oral or intramuscular administration although there have been no estimates of absolute bioavailabilily.
Clinical pharmacokinetics pharmacokinetics adme and. The increase in digoxin serum concentration is directly, but not linearly, related to the dose ofquinidine 11,40. Bibliographic information bibliographic information. Digoxin is the primary cardiac glycoside in clinical use. Creatinine clearance lean body weight digoxin therapy general medical. Digitalis glycosides, like digoxin, have been used for more than 200 years to treat heart failure, but until recently, have had little clinical evidence to support their use in heart failure. The influence of chronic perindopril treatment on digoxin pharmacokinetics was investigated in 10 patients with mild chronic heart failure under stable diuretic and digitalis treatment and normal renal function. Considerations for use from the atrial fibrillation toolkit. Basic clinical pharmacokinetics edition 5 by michael e. Pharmacokinetics made easy 1rpresents the complex subject of pharmacokinetics in a simple, easytounderstand manner, lending itself to a wide audience including medical practitioners, health professionals and students of pharmacology, medicine and nursing. Home tools and practice support clinical toolkits atrial fibrillation toolkit recommended therapies for heart rate and rhythm control in patients with atrial fibrillation digoxin. Potassiumsparing diuretic drugs, such as spironolactone, can alter digoxin pharmacokinetics. Aging is an ongoing process that culminates in structural and functional changes in older populations and these changes have marked affects on critical organ systems. Pharmacokinetics of digoxin crossreacting substances in patients with acute yellow oleander thevetia peruviana poisoning, including the effect of activated charcoal.
Indomethacin may decrease renal excretion of digoxin in preterm infants. The pharmacodynamic effects of digoxin, including toxic symptoms, are correlated with the uptake of digoxin in the heart after a single dose and with the steady state serum digoxin concentration during maintenance therapy. Three subjects were first given a digoxin tablet in the fasting state and subsequently received the same formulation in the fed state, to simulate a spurious oral bioavailability difference. Today i would like to talk to you about the clinical pharmacokinetics of digoxin. When changing from parenteral to oral dose forms, dose adjustments may be necessary because of pharmacokinetic variations in percentage of digoxin absorbed. Apr 23, 20 pharmacokinetics about 70 to 80% of an oral dose of digoxin is absorbed, mainly in the proximal part of the small intestine.
Dr goran wettrell, dr karlerik andersson pages 1731. Digoxin is taken by mouth or by injection into a vein. Clinical pharmacokinetics of cardiac glycosides in patients with renal dysfunction. Pharmacokinetic interactions between digoxin and other. In obtaining this therapeutic goal, it is assumed that there is an appropriate target concentration that will produce the desired. Departments of pharmaceutics and medicine, schools of pharmacy and medicine, state university of new york at buffalo, buffalo, n. Murphy although william withering reported effects of his digitalis preparation on such clinically important body functions as disappearance of dropsy, character and frequency of the pulse, nausea, vomiting, and diarrhea, few studies on pharmacokinetics.
Clinical pharmacokinetics of digitoxin university of arizona. After an iv dose is administered, plasma concentrations rise and then rapidly decline as drug distributes out of plasma and into muscle tissue. The pharmacodynamic effects of digoxin include increased cardiac output, decreased pulmonary capillary wedge pressure, and increased ejection fraction. Clinical challenges in therapeutic drug monitoring.
Clinical pharmacokinetics, volume 2, issue 1 springer. Pharmacokinetics of digoxin crossreacting substances in. For digoxin tablets variability in the bioavailability of digoxin tablets was recognized as a clinical problem in the early 1970s. It is used to treat mild to moderate heart failure as well as atrial fibrillation. Basic clinical pharmacokinetics was designed to simplify. Clinical pharmacokinetics, 6th edition, edited by john e murphy. Students like that each chapter includes sample problems throughout the chapter, with a ton of practice problems. Book title cardiac glycosides book subtitle part ii. There is only one study that has examined the relative bioavailability of two commercial digitoxin tablets usa and no differences. Digoxin may be considered for the in utero management of fetal svt or atrial flutter with hydrops or ventricular dysfunction. Although the fourth edition of concepts in clinical pharmacokinetics continues to provide basic pharmacokinetic concepts and procedures that are useful in pharmacy, medicine, and other health professions, this new edition has been revised to be, we anticipate, even more instructive and userfriendly for the reader. Pharmacokinetics and anticoagulation service uk healthcare.
Is the volume of distribution of digoxin reduced in patients with renal dysfunction. The neurohormonal effects of digoxin include improved baroreceptor sensitivity, decreased norepinephrine concentration, decreased reninangiotensin activations, sympathoinhibitory effect, and increase release of atrial natriuretic peptide and brain natriuretic peptide. The new, fifth edition of this popular teaching and selfinstructional text makes it easier than ever to acquire a strong foundation in the basic principles of pharmacokinetics. Digoxin pharmacokinetics in congestive heart failure. The aim of applying pharmacokinetic principles is to. A rational approach to this objective combines the principles of pharmacokinetics with pharmacodynamics to clarify the doseeffect relationship figure 31. Tw smithcontribution of quantitative assay technics to the understanding of the clinical pharmacology of digitalis. By its positive inotropic effect, digoxin increases the cardiac muscular force of contraction.
1023 405 1052 165 533 867 1463 59 593 1497 77 1082 1024 115 24 1412 239 713 904 974 311 578 69 1288 945 780 981 1054 1460 879 252 922 1201 364 1289 491 616 1232 1243 1341