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Digoxin elimination in a functionally anephric patient after digoxin-specific Fab fragment therapy
1Department of Pathology, College of Medicine, University of Iowa, Iowa City 52242.
Therapeutic Drug Monitoring
|November 1, 1989
Summary
Digoxin-specific Fab fragment therapy in end-stage renal disease patients shows biphasic digoxin elimination. This therapy effectively reduces total digoxin levels, with distinct fast and slow elimination phases observed.
Area of Science:
- Pharmacokinetics
- Nephrology
- Toxicology
Background:
- Digoxin toxicity management in end-stage renal disease (ESRD) presents challenges due to impaired renal clearance.
- Digoxin-specific Fab fragments are indicated for life-threatening digoxin poisoning.
Observation:
- This study details digoxin elimination in an ESRD patient following digoxin-specific Fab fragment administration.
- Biphasic elimination was observed, characterized by a rapid initial phase and a prolonged slower phase.
Findings:
- The fast elimination phase half-life was 43 hours, and the slow phase half-life was 330 hours.
- Serum total digoxin concentration decreased by 20% within 12 hours of Fab therapy initiation.
- Mean total and apparent total digoxin concentrations were 18.42 and 14.77 ng/ml, respectively, over 520 hours (r=0.987).
- Free digoxin concentrations varied significantly with temperature (0.35 ng/ml at 2°C vs. 0.82 ng/ml at 37°C).
Implications:
- Digoxin-specific Fab fragments offer an effective treatment for digoxin toxicity in ESRD patients.
- Understanding the biphasic elimination kinetics is crucial for monitoring and managing patients post-therapy.
- Temperature-dependent free digoxin levels highlight the importance of assay conditions in interpreting results.