Pharmacokinetic Design of Digoxin Dosage Regimens in Relation to Renal Function

T HE incidence of adverse effects during empirical therapy with digoxin (that is, therapy without monitoring serum concentrations of digoxin) has been assessed as 18 per cent ill the general medical patient population’ and as high as 70 per cent in patients with severe renal impairment.2 This high frequency of toxicity was primarily due to overdosage, and recent studies have shown that it can be diminished by monitoring serum concentrations of the drug3 and by use of pharmacokinetic principles to devise dosage reginiens.4 The latter involves the calculation of (1) a digoxin loading dose based on a volume of distribution which is proportional to the lean body mass and (2) a maintenance dose related to the renal function of the patient.4’5 Renal function is usually assessed from the creatinine clearance, and such calculations are thus dependent on a known and reliable relationship between the

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