[Personalized pharmacotherapy of digoxin]

Area of Science:

• Pharmacology and Therapeutics
• Clinical Chemistry
• Geriatric Medicine

Background:

• Digoxin's therapeutic and toxic effects are concentration-dependent.
• Emerging evidence supports a lower therapeutic range (0.5-0.9 ng/ml) for reduced mortality.
• Optimizing digoxin dosage is critical for patient safety and efficacy.

Purpose of the Study:

• To demonstrate the benefits of therapeutic drug monitoring (TDM) in digoxin dosing.
• To illustrate how TDM aids in achieving optimal serum digoxin concentrations.

Main Methods:

• Serum digoxin trough levels were measured using immunoassay (MEIA, AxSym Abbott).
• Bayesian analysis with MW-Pharm 3.30 software predicted long-term digoxin concentration-time profiles.
• Case reports of elderly patients (71-92 years) were analyzed.

Main Results:

• Individualized digoxin doses ranging from 0.03-0.25 mg/day were determined.
• These varied doses successfully achieved therapeutic serum digoxin levels within the target range.
• Case studies highlight the personalized approach required for digoxin management.

Conclusions:

• Therapeutic drug monitoring is highly effective for predicting and managing serum digoxin levels.
• TDM allows for timely dose adjustments without requiring a steady-state condition.
• This facilitates prompt optimization of digoxin therapy, enhancing patient care.