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The posology and trough concentrations of digoxin in adult and elderly patients

Authorized Users Only
2016
Authors
Bajraktarević, Azra
Mehmedagić, Aida
Vučićević, Katarina
Kulić, Mehmed
Miljković, Branislava
Article (Published version)
Metadata
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Abstract
Being a narrow therapeutic index drug, digoxin may cause harm if dosed without regular measurements of serum levels. Due to various limitations in its dosing, different challenges still exist in clinical practice. This study aimed to assess digoxin though concentrations after different regimens in adult and elderly patients, and to identify predictor variables for the ratio of given dose and digoxin trough level. This was prospective open-label study. Digoxin was administered per os as 0.125. or 0.25 mg during different continuous and interrupted dosage regimens. Study protocol allowed an additional therapy according to contemporary guidelines. Digoxin concentrations were determined using Abbott AxSYM Digoxin II assay in trough samples (1-3 per patient) after 3-4 weeks stable regimen. In total, 191 concentrations (104 patients) were analyzed. Digoxin weekly dose was in range 0.375-1.75 mg. On average, we observed slightly lower digoxin levels in 1-117 patients. Results showed that in p...atients receiving digoxin with interrupted dosage regimen post pause digoxin level was statistically significantly lower than pre-pause (p lt 0.05). Based on multiple linear regression, the ratio of given dose and trough concentration was mainly predicted by clearance creatinine, and to lesser extent by patient's ideal body weight. Interrupted dosing schedule shows greater variability in drug levels comparing to continuous dosing, and it additionally causes difficulties in reaching and maintaining steady trough levels between doses. Hence, individualization of dosing regimen should he carefully guided based on target levels and not solely on clinical signs and symptoms.

Keywords:
Digoxin / Dosing regimen / Pharmacokinetics / Therapeutic drug monitoring
Source:
Acta Poloniae Pharmaceutica - Drug Research, 2016, 73, 5, 1361-1368
Publisher:
  • Polskie Towarzystwo Farmaceutyczne, Warsaw
Funding / projects:
  • Faculty of Pharmacy, University of Sarajevo, Bosnia and Herzegovina
  • Basic and Clinical Pharmacological research of mechanisms of action and drug interactions in nervous and cardiovascular system (RS-175023)

ISSN: 0001-6837

PubMed: 29638076

WoS: 000394080700027

Scopus: 2-s2.0-84990967227
[ Google Scholar ]
Handle
https://hdl.handle.net/21.15107/rcub_farfar_2667
URI
https://farfar.pharmacy.bg.ac.rs/handle/123456789/2667
Collections
  • Radovi istraživača / Researchers’ publications
Institution/Community
Pharmacy
TY  - JOUR
AU  - Bajraktarević, Azra
AU  - Mehmedagić, Aida
AU  - Vučićević, Katarina
AU  - Kulić, Mehmed
AU  - Miljković, Branislava
PY  - 2016
UR  - https://farfar.pharmacy.bg.ac.rs/handle/123456789/2667
AB  - Being a narrow therapeutic index drug, digoxin may cause harm if dosed without regular measurements of serum levels. Due to various limitations in its dosing, different challenges still exist in clinical practice. This study aimed to assess digoxin though concentrations after different regimens in adult and elderly patients, and to identify predictor variables for the ratio of given dose and digoxin trough level. This was prospective open-label study. Digoxin was administered per os as 0.125. or 0.25 mg during different continuous and interrupted dosage regimens. Study protocol allowed an additional therapy according to contemporary guidelines. Digoxin concentrations were determined using Abbott AxSYM Digoxin II assay in trough samples (1-3 per patient) after 3-4 weeks stable regimen. In total, 191 concentrations (104 patients) were analyzed. Digoxin weekly dose was in range 0.375-1.75 mg. On average, we observed slightly lower digoxin levels in 1-117 patients. Results showed that in patients receiving digoxin with interrupted dosage regimen post pause digoxin level was statistically significantly lower than pre-pause (p  lt  0.05). Based on multiple linear regression, the ratio of given dose and trough concentration was mainly predicted by clearance creatinine, and to lesser extent by patient's ideal body weight. Interrupted dosing schedule shows greater variability in drug levels comparing to continuous dosing, and it additionally causes difficulties in reaching and maintaining steady trough levels between doses. Hence, individualization of dosing regimen should he carefully guided based on target levels and not solely on clinical signs and symptoms.
PB  - Polskie Towarzystwo Farmaceutyczne, Warsaw
T2  - Acta Poloniae Pharmaceutica - Drug Research
T1  - The posology and trough concentrations of digoxin in adult and elderly patients
VL  - 73
IS  - 5
SP  - 1361
EP  - 1368
UR  - https://hdl.handle.net/21.15107/rcub_farfar_2667
ER  - 
@article{
author = "Bajraktarević, Azra and Mehmedagić, Aida and Vučićević, Katarina and Kulić, Mehmed and Miljković, Branislava",
year = "2016",
abstract = "Being a narrow therapeutic index drug, digoxin may cause harm if dosed without regular measurements of serum levels. Due to various limitations in its dosing, different challenges still exist in clinical practice. This study aimed to assess digoxin though concentrations after different regimens in adult and elderly patients, and to identify predictor variables for the ratio of given dose and digoxin trough level. This was prospective open-label study. Digoxin was administered per os as 0.125. or 0.25 mg during different continuous and interrupted dosage regimens. Study protocol allowed an additional therapy according to contemporary guidelines. Digoxin concentrations were determined using Abbott AxSYM Digoxin II assay in trough samples (1-3 per patient) after 3-4 weeks stable regimen. In total, 191 concentrations (104 patients) were analyzed. Digoxin weekly dose was in range 0.375-1.75 mg. On average, we observed slightly lower digoxin levels in 1-117 patients. Results showed that in patients receiving digoxin with interrupted dosage regimen post pause digoxin level was statistically significantly lower than pre-pause (p  lt  0.05). Based on multiple linear regression, the ratio of given dose and trough concentration was mainly predicted by clearance creatinine, and to lesser extent by patient's ideal body weight. Interrupted dosing schedule shows greater variability in drug levels comparing to continuous dosing, and it additionally causes difficulties in reaching and maintaining steady trough levels between doses. Hence, individualization of dosing regimen should he carefully guided based on target levels and not solely on clinical signs and symptoms.",
publisher = "Polskie Towarzystwo Farmaceutyczne, Warsaw",
journal = "Acta Poloniae Pharmaceutica - Drug Research",
title = "The posology and trough concentrations of digoxin in adult and elderly patients",
volume = "73",
number = "5",
pages = "1361-1368",
url = "https://hdl.handle.net/21.15107/rcub_farfar_2667"
}
Bajraktarević, A., Mehmedagić, A., Vučićević, K., Kulić, M.,& Miljković, B.. (2016). The posology and trough concentrations of digoxin in adult and elderly patients. in Acta Poloniae Pharmaceutica - Drug Research
Polskie Towarzystwo Farmaceutyczne, Warsaw., 73(5), 1361-1368.
https://hdl.handle.net/21.15107/rcub_farfar_2667
Bajraktarević A, Mehmedagić A, Vučićević K, Kulić M, Miljković B. The posology and trough concentrations of digoxin in adult and elderly patients. in Acta Poloniae Pharmaceutica - Drug Research. 2016;73(5):1361-1368.
https://hdl.handle.net/21.15107/rcub_farfar_2667 .
Bajraktarević, Azra, Mehmedagić, Aida, Vučićević, Katarina, Kulić, Mehmed, Miljković, Branislava, "The posology and trough concentrations of digoxin in adult and elderly patients" in Acta Poloniae Pharmaceutica - Drug Research, 73, no. 5 (2016):1361-1368,
https://hdl.handle.net/21.15107/rcub_farfar_2667 .

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