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Transition from Lanoxin capsules to Lanoxin tablets in the debilitated elderly
P J Drinka1, D A Nickel, G W Schomisch
1Wisconsin Veterans Home, King 54946.
DICP : the Annals of Pharmacotherapy
|April 1, 1990
Summary
Digoxin levels were higher when patients switched from Lanoxin capsules to tablets, despite manufacturer claims of equivalent dosing. This suggests a potential need for dose adjustment when changing formulations.
Area of Science:
- Pharmacology
- Clinical Pharmacy
Background:
- Lanoxin (digoxin) is available in capsule and tablet forms.
- Capsules offer faster absorption and less metabolism by gut bacteria compared to tablets.
- Manufacturer dosing equivalence: 0.25 mg tablet ≈ 0.20 mg capsule.
Purpose of the Study:
- To compare digoxin concentrations in patients transitioning from Lanoxin capsules to tablets.
- To assess the impact of formulation change on serum digoxin levels.
Main Methods:
- Thirty-nine patients had serum digoxin levels measured before and after switching from capsules to tablets.
- Patients with confounding medication changes or acute illness exacerbations were excluded.
- Paired t-test used for statistical comparison of digoxin concentrations.
Main Results:
- Mean digoxin concentration on capsules: 0.92 ± 0.26 ng/mL.
- Mean digoxin concentration on tablets: 1.03 ± 0.29 ng/mL.
- Digoxin concentrations were significantly higher on tablets (mean difference 0.11 ng/mL, p = 0.0028).
Conclusions:
- Transitioning from Lanoxin capsules to tablets resulted in significantly higher serum digoxin concentrations.
- The manufacturer's stated dose equivalence may not fully account for pharmacokinetic differences.
- Clinical monitoring and potential dose adjustments are warranted when switching digoxin formulations.