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[Current clinical interest in monitoring digoxinemia]
1Cattedra di Fisiopatologia Clinica, Università degli Studi di Palerma.
Insights
Optimizing digitalis (digoxin) therapy for supraventricular arrhythmias is challenging. Therapeutic digoxin levels were achieved in only 43.8% initially, but improved to 80% after dose adjustments guided by digoxinaemia monitoring.
Area of Science:
- Cardiology
- Clinical Pharmacology
Context:
- Digitalis (digoxin) is crucial for supraventricular arrhythmias.
- Achieving optimal drug dosage is often difficult.
Purpose:
- To evaluate the effectiveness of digoxinaemia monitoring in achieving therapeutic digoxin levels.
- To assess the impact of dose adjustments guided by blood levels.
Summary:
- Initial digoxinaemia monitoring revealed only 43.8% of patients were within the therapeutic range.
- After 5 days of monitoring, 80% of patients achieved therapeutic digoxin levels.
- Dose adjustments driven by digoxinaemia measurements improved therapeutic outcomes.
Impact:
- Digoxinaemia determination is essential for guiding digitalis treatment.
- This monitoring facilitates optimal posology and patient outcomes.
- Highlights the importance of therapeutic drug monitoring in clinical practice.
Abstract:
After a short introduction about the current role of digitalis in the treatment of the supraventrical arrhythmias and about the factors that make often problematic the achievement of an optimal posology of the drug, the results relative to more recent 340 digoxinaemia determinations in patients of Policlinico in Palermo or in outpatients are presented. Just the 43.8% of the patients had a digoxinaemia value in the range considered therapeutic; just 45 patients (32.1%), out of the 140 in which the digoxinaemia had been monitored for, at least, 5 days, were in the therapeutic range at the first determination; the 47.8% of the patients were underdosed and the 38.8% of them showed higher values than the therapeutic range. Determination 5 or more days later showed digoxinaemia values in the therapeutic range in 112 patients (80%). According to the reported results, it may be presumed that the posology correction effectuated by the physician on these patients might have been driven by the digoxinaemia values, whose determination must be considered an unavoidable guide to the digitalis treatment.