Jove
Visualize
Contact Us
JoVE
x logofacebook logolinkedin logoyoutube logo
ABOUT JoVE
OverviewLeadershipBlogJoVE Help Center
AUTHORS
Publishing ProcessEditorial BoardScope & PoliciesPeer ReviewFAQSubmit
LIBRARIANS
TestimonialsSubscriptionsAccessResourcesLibrary Advisory BoardFAQ
RESEARCH
JoVE JournalMethods CollectionsJoVE Encyclopedia of ExperimentsArchive
EDUCATION
JoVE CoreJoVE BusinessJoVE Science EducationJoVE Lab ManualFaculty Resource CenterFaculty Site
Terms & Conditions of Use
Privacy Policy
Policies

Related Experiment Videos

Spironolactone-associated digoxin radioimmunoassay interference

B Silber, L B Sheiner, J L Powers

    Clinical Chemistry
    |January 1, 1979
    PubMed
    Summary

    Spironolactone use can falsely elevate digoxin measurements in patients, especially with certain radioimmunoassays (RIAs). This interference is likely due to spironolactone metabolites, not canrenone itself, highlighting the need for specific assay validation.

    Related Concept Videos

    You might also read

    Related Articles

    Articles linked to this work by shared authors, journal, and citation graph.

    Sort by
    Same author

    The Pharmacogenomics Research Network Translational Pharmacogenetics Program: Outcomes and Metrics of Pharmacogenetic Implementations Across Diverse Healthcare Systems.

    Clinical pharmacology and therapeutics·2017
    Same author

    Transcriptomic variation of pharmacogenes in multiple human tissues and lymphoblastoid cell lines.

    The pharmacogenomics journal·2016
    Same author

    Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for CYP3A5 Genotype and Tacrolimus Dosing.

    Clinical pharmacology and therapeutics·2015
    Same author

    Pharmacodynamic measurements of methyl nicotinate percutaneous absorption.

    Pharmaceutical research·2013
    Same author

    Radioreceptor assay of narcotic analgesics in serum.

    Pharmaceutical research·2013
    Same author

    Protein drugs: a revolution in therapy?

    Pharmaceutical research·2013

    Area of Science:

    • Pharmacology
    • Clinical Chemistry
    • Analytical Chemistry

    Background:

    • Digoxin is a critical medication for heart conditions, requiring accurate serum level monitoring.
    • Spironolactone, a common diuretic, may interfere with digoxin assays, potentially leading to misinterpretation of results.
    • Previous studies have indicated potential cross-reactivity in digoxin immunoassays, but the specific interfering substances remain unclear.

    Purpose of the Study:

    • To investigate the impact of spironolactone administration on apparent digoxin serum concentrations.
    • To identify the specific spironolactone metabolites responsible for assay interference.
    • To recommend appropriate methods for validating digoxin assay specificity in clinical practice.

    Main Methods:

    • Serum digoxin levels were measured in 21 spironolactone users and 21 controls using two radioimmunoassays (RIAs): sequential-saturation 3H-RIA and equilibrium 125I-RIA.

    Related Experiment Videos

  • Canrenone, a major spironolactone metabolite, was quantified using liquid chromatography.
  • The correlation between canrenone levels and apparent digoxin concentrations was assessed; canrenone interference was tested by spiking control serum.

    • Main Results:

    • Apparent digoxin levels were significantly higher in spironolactone users compared to controls (p < 0.05).
    • The equilibrium 125I-RIA showed elevated "digoxin" values in the therapeutic range for spironolactone users, unlike the 3H-RIA.
    • Canrenone correlated with apparent digoxin by 125I-RIA, but spiking experiments indicated other spironolactone metabolites were the primary interferents.

    Conclusions:

    • Spironolactone metabolites, beyond canrenone, cause significant interference in certain digoxin immunoassays, particularly the equilibrium 125I-RIA.
    • Assay interference depends on antibody specificity, leading to falsely elevated digoxin levels.
    • Clinical laboratories must validate digoxin assay specificity using spironolactone-treated patient serum, not fortified control serum, to ensure accurate patient management.