Combination of personalized medicine and digoxin monitoring
发布日期：
2024-07-17
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digoxin


Combination of personalized medicine and digoxin monitoring

Digoxin is a cardiac glycoside analog used primarily in the treatment of heart failure and atrial fibrillation. Due to the close proximity of its effective therapeutic and toxic concentrations, it is particularly important to individualize treatment and monitor drug concentrations in patients.






Mechanism of action of digoxin




Digoxin enhances myocardial contractility by inhibiting cell membrane-bound Na+/K+ ATPase and increasing intracellular sodium ion concentration, which in turn promotes calcium ion inward flow. It also has the effect of slowing AV node conduction and increasing vagal activity, thus helping to control heart rate. However, the metabolism and excretion of digoxin in the body are affected by a number of factors, including renal function, age, drug interactions and genetic polymorphisms. Therefore, strict monitoring of its blood levels is required in clinical use.



Need for therapeutic drug monitoring




1.Narrow therapeutic window and individual differences

Digoxin has a narrow therapeutic window, with a commonly recommended therapeutic concentration range of 0.5-2.0 ng/mL. however, concentrations above 2.0 ng/mL predispose the patient to toxicity. Due to inter-individual differences in sensitivity to digoxin, different patients may exhibit different potencies and toxicities at the same dose. Individualized dose adjustment is dependent on blood concentration monitoring.



2. Prevention of drug poisoning

Digoxin toxicity is a common clinical problem, more prominent in elderly patients and patients with renal insufficiency. Clinical studies have shown that the incidence of digoxin-related toxicity can be significantly reduced and serious adverse effects can be avoided by strict drug monitoring.



3. Drug interactions

There are interactions between digoxin and a variety of drugs, such as quinidine, amiodarone, verapamil and certain antibiotics, which can alter the blood concentration of digoxin by affecting its absorption, distribution, metabolism and excretion. By monitoring blood levels, drug interactions can be detected and managed in a timely manner to ensure the safety and efficacy of treatment.



4. Patient compliance and dose adjustment

Blood concentration monitoring not only helps to assess patient compliance, but also provides a basis for dose adjustment. With regular monitoring, dosage can be adjusted dynamically, making drug therapy more precise and effective.



Monitoring strategy and methodology



01

Timing of monitoring

Initial blood concentration measurements are usually recommended within 5-7 days after initiation of therapy, followed by periodic reviews based on patient-specific conditions and response to therapy. The frequency of monitoring should be increased appropriately in patients who experience dose adjustments, changes in renal function, or changes in co-medication.


Sample collection

02

Blood collection should be performed 6-8 hours after digoxin administration or before the next dose to ensure that blood concentrations reach steady state.

03

Analytical methods

UPLC-MS method/chemiluminescence immunoassay, etc.



 Diagreat’s Digoxin Test Kit Introduction 

Product Name:

Digoxin

Methodology: 

Fluorescent immunochromatography

Sample type: 

Serum/plasma/whole blood

Detection range:

0.2-5ng/ml

Testing time: 

15min


Conclusion

Digoxin drug therapy concentration monitoring is of great significance in clinical treatment. Through reasonable concentration monitoring, individualized medication can be achieved, the risk of poisoning can be reduced, and the effectiveness and safety of the drug can be ensured. In the future, with the continuous progress of drug monitoring technology and the development of individualized medicine, the fine management of digoxin therapy will be further improved, bringing more benefits to patients.


Reference：

1.Kirchhof, P., Benussi, S., Kotecha, D., et al. (2016). 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal, 37(38), 2893-2962.
2.Hood, S. R., & Kendrick, J. G. (2019). Digoxin toxicity: Case for modification of management in the modern era. Cardiovascular Drugs and Therapy, 33(1), 123-132.
3.Hauptman, P. J., & Kelly, R. A. (1999). Digitalis. Circulation, 99(9), 1265-1270.


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