Monitoring drug concentration of digoxin among patients with heart failure

Chen Gang; Chen Xiaoli

doi:10.3760/cma.j.issn.1673-4777.2014.04.002

Abstract：Objective To discuss the necessity on serum concentration monitoring of herat failure patients treated by digoxin.Methods Three hundred cases of heart failure received in our hospital from March 2010 to March 2013 were selected.All patients were treated with digoxin oral and the maintenance dose was 0.125-0.250 mg/d,and all patients were taking more than 5 times the half-life.All patients were divided into group A (0.125 mg/d digoxin,193 cases) and group B (0.250 mg/d digoxin,107 cases) according to digoxin dosage.Fluorescence polarization immunoassay method were used for monitoring the digoxin serum concentrations in patients with heart failure,the relationship of serum concentrations monitoring results with different doses of digoxin,the relationship of different oral doses of digoxin with the clinical efficacy,and the relationship of different digoxin plasma concentrations with the clinical efficacy were analyzed and compared.Results The proportion of patients of digoxin plasma concentration ＜ 0.8 μg/L and 0.8-1.4 μg/L in group A were significantly more than the dose of group B [13.0％ (25 cases)vs 1.9％ (2 cases),24.4％ (47 cases) vs 7.5％ (8 cases)],the differences were statistically significant (x2 =10.33,13.09,P ＜ 0.05) ; The proportion of patients of digoxin serum concentrations ＞ 2.0 μg/L in digoxin dose of group A was significantly less than the dose of group B [4.1％ (8 cases) vs 37.4％ (40 cases)],the difference was statistically significant (x2 =45.74,P ＜ 0.05) ; The effective rate in digoxin dose of group A was 80.3％,which was significantly higher than the dose of group B (65.4％),the difference was statistically significant (x2 =8.14,P ＜ 0.05) ; The poisoning rate in digoxin dose of group A was 7.8％,which was significantly lower than that dose of group B (16.8％),the difference was statistically significant (x2 =5.76,P ＜ 0.05).When plasma digoxin concentrations were below 0.8 μg/L,the patients' invalid rate was significantly higher than drug concentration of digoxin 0.8-1.4,1.5-2.0,＞ 2.0 μg/L group [81.5％ (22/27) vs 36.4％ (20/27),0,0] ; the difference was statistically significant (x2 =42.03,137.60,137.60,P ＜0.05) ; And when digoxin plasma concentration was 1.5-2.0 μg/L,the patient's clinical effective rate was significantly higher than drug concentration of digoxin 0.8-1.4,1.5-2.0,＞ 2.0 μg/L group [94.1％ (160/170) vs 18.5c％ (5/27),63.6 (35/55),52.1％ (25/48)],the difference was statistically significant (x2 =116.20,27.89,44.85,P ＜ 0.05) ; When local digoxin concentrations higher than 2.0 μg/L,the poisoning rate was significantly higher than drug concentration of digoxin 0.8-1.4,1.5-2.0,＞ 2.0 μg/L group[47.9％ (23/48) vs 0,0,5.9％ (10/ 170)],the difference was statistically significant (x2 =62.98,62.98,44.85,P ＜ 0.05).Conclusion When using digoxin for the treatment of patients with heart failure,the blood drug concentration monitoring is necessary ; the dose needs to be adjusted from time to time based on the real-time monitoring results in order to ensure that patient's outcomes while preventing drug overdose poisoning.