Is there any reason why digoxin shouldn't be taken at night rather than the
morning? Measure levels first thing in the morning.
Paul Robinson
Reading
-----Original Message-----
From: Ball, Graham
To: [log in to unmask]
Sent: 29/05/2003 11:12
Subject: Re: BNP draft guidance
We used to recommend 6-8 hours post dose but now recommend at least 6
hours post-dose.
With a long half life (36 hours, or more in renal impairment) the timing
is not that critical.
It is ofren easier to get a sample before a morning dose than to get one
in the afternoon.
The important thing is not to take the sample in the initial
distribution phase when plasma levels will not reflect tissue levels.
Graham Ball
-----Original Message-----
From: Mascall, Gary (Biochemistry)
[SMTP:[log in to unmask]]
Sent: 29 May 2003 10:13
To: [log in to unmask]
Subject: Re: BNP draft guidance
Regarding one of the recommendations, we have had some
discussions locally about the timing of blood samples collected to
monitor Digoxin treated patients.
Locally two labs have used the recommendations of the regional
Toxicology dept, samples 6 to 8 hours post does (agrees well with
Therapeutic Driug monitoring by Hallworth and Capps). One recommends
samples at 24 hours post dose, this coming from their Pharmacists who
interpret the drug levels and advise on dosage.
NICE guidance indicates at least 8 hours post dose.
So, what recommendations are others giving their users, and what
is the evidence base for the longer time periods??
On a related point, after the recent EQA circulation with added
Digibind, we are looking to add a form of words to all Digoxin reports
warning about the possible erroneous results in patients treated with
this drug, does anyone else do this, if so, would you be willing to
share your comments, as this needs to be relatively standard across the
country, as I'll bet most junior doctors at the coal face are unaware of
this fact, local ones certainly were.
Gary Mascall (Consultant in Clinical Biochemistry)
Clinical Biochemistry Department
Kidderminster Hospital
Worcestershire Acute Hospitals NHS Trust
Tel : 01562 823424 Extn 53465
email : [log in to unmask]
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-----Original Message-----
From: Lester Geoff [ mailto:[log in to unmask]
<mailto:[log in to unmask]> ]
Sent: 29 May 2003 09:51
To: [log in to unmask]
Subject: Re: BNP draft guidance
Thanks all responders (especially Sophie Barnes).
The document I was seeking was draft NICE guidance
( http://www.nice.org.uk/cat.asp?c=21348
<http://www.nice.org.uk/cat.asp?c=21348> or
http://www.nice.org.uk/pdf/HF_NICE_guideline_secondconsultation.pdf
<http://www.nice.org.uk/pdf/HF_NICE_guideline_secondconsultation.pdf> )
rather than a NSF. Makes compulsory reading.
Geoff Lester
Consultant Biochemist
Royal Berkshire Hospital
Reading
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