Authors: M. Grundmann 1; I. Kacířová 1,2 Authors place of work: Ústav klinické farmakologie, LF OU, Ostrava 1; Oddělení klinické farmakologie, Ústav laboratorní dia gnostiky, FN Ostrava 2 Published in the journal: Kardiol Rev Int Med 2015, 17(1): 65-69 Category: Interní medicína
Introduction: Digoxin is a positive inotropic drug frequently prescribed in the treatment of chronic congestive cardiac failure. Recent evidence suggests that a lower therapeutic range of 0.5 – 0.9 ng/ mL is associated with reduced mortality. With complex pharmacokinetic profile and narrow therapeutic index, its use in managing patients with heart failure can present a challenge to clinicians.
Aim: To show the advantages of therapeutic drug monitoring for dosing of digoxin.
Method: Bayesian analysis was used to predict the long‑term serum concentration – time profiles of digoxin, using the MW ‑ Pharm 3.30 software. The serum levels of digoxin were determined by MEIA.
Results: Three case reports are presented showing a prediction of steady ‑ state digoxin level three days after the start of administration, drug‑drug interaction between digoxin and spironolactone/ carvedilol and an example of long‑term patient non‑compliance.
Conclusion: Therapeutic drug monitoring is very useful for prediction of serum levels of digoxin alone and in combination with different interacting drugs. It helps to understand compliance ‑ influencing factors and to improve interventional strategies to increase digoxin compliance.
Keywords: chronic heart failure – digoxin – therapeutic drug monitoring – compliance – drug‑drug interactions
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