And also: "It is important to check serum electrolytes and creatinine at
least annually in people taking digoxin, to assess renal function and
potassium levels. This is particularly important if they are also taking
diuretics".
According to the results of these tests, therapeutic ranges for digoxin must
be reconsidered too.
Joseph Watine, Rodez, France
>From: Paul Masters <[log in to unmask]>
>Reply-To: Paul Masters <[log in to unmask]>
>To: [log in to unmask]
>Subject: Re: Digoxin reference ranges
>Date: Fri, 10 Jun 2005 10:26:57 +0100
>
>Chris
>You would need to make it clear that such a range was only applicable when
>digoxin was being used for heart failure.
>The other major indication is atrial fibrillation and different ranges
>would apply. UK guidelines suggest it needn't be measured routinely in AF
>as pulse rate is an adequate marker of response, see:
>
>http://www.prodigy.nhs.uk/guidance.asp?gt=Atrial%20fibrillation
>
>Paul
>
>
>On Fri, 10 Jun 2005 14:17:25 +1200, Chris Florkowski
><[log in to unmask]> wrote:
>
> >We currently quote a DIGOXIN therapeutic range 1.0 - 2.5 nmol/L, which
> >we think is widely used in other centres.
> >
> >Although digoxin levels alone are not necessarily a guide to toxicity,
> >there is evidence that adverse effects, including ECG changes are
> >manifest at levels >1.9 nmol/l. Furthermore, post-hoc analysis of the
> >Digitalis Intervention Group (DIG) Trial in men with LVEF<45% showed
> >that those men with digoxin levels >1.6 nmol/l had an 11.8% higher
> >absolute mortality (JAMA 2003; 289: 871-8) than those on placebo. Those
> >patients with digoxin concentrations in the range 0.64-1.02 nmol/l had
> >6.3% lower mortality.
> >
> >The traditional teaching is that if digoxin levels are under 1 nmol/l,
> >clinical condition is unlikely to deteriorate if the drug is stopped
> >(TDM& Clinical Biochemistry; Hallworth & Capps; 1993. p59). This may not
> >necessarily be true.
> >
> >Given the findings of the DIG trial, we propose to adjust our
> >therapeutic range to 0.6 - 2.0 nmol/l
> >Any thoughts or feedback from other centres would be appreciated
> >regarding this impetus for change.
> >
> >Chris Florkowski
> >Chemical Pathologist & Associate Professor
> >Canterbury Health Laboratories
> >Christchurch, NZ
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