Digoxin drug monitoring

Steimer W, Muller C, Eber B, EmmanuUidis K. Intoxication due to negative canrenone interference in digoxin drug monitoring. Lancet 1999 354(9185) 1176-7. 

Aronson JK. Digoxin clinical aspects. In Richens A, Marks V, editors. Therapeutic Drug Monitoring. London, Edinburgh Churchill-Livingstone, 198L404. 

Horn, J.R. Christensen, D.B. deBlaquire, P.A. Evaluation of a digoxin pharmacokinetic monitoring service in a community hospital. Drug Intell. Clin. Pharm. 1985, 19, 45 52. 

To evaluate effectiveness of serum digoxin concentration monitoring, and determine cost impact of service OD None None NOI, timing of digoxin serum concentrations, laboratory costs avoided Decreased number of digoxin serum drug concentrations ordered Input costs not considered... 

Perhaps the best laboratory test to compare with pharmacogenetic testing is a drug blood level, technically called therapeutic drug monitoring (TDM), which could be considered a phenotypic test of metabolic enzymes [97]. Almost no studies of TDM cost effectiveness exist [98], except for some studies of antibiotics. However, TDM appears to be standard clinical practice (medical insurers routinely reimburse for it) for classic anticonvulsants, theophylline, digoxin, immunosuppressants, and some psychiatric drugs [98]. 

Data from Reuning RH, Geraets DR, Rood ML, Vlasses PH. Digoxin. In Evans WE, Schentag JJ, jusko WJ, eds. Applied Pharmacokinetics Principles of Therapeutic Drug Monitoring, 3d ed. Spokane, WA, Applied Therapeutics, 1992 20-1-20-48. 

Digoxin (among patients with renal Therapeutic drug monitoring recommended may require digoxin or... 

Avoid the concomitant use of herbs that contain cardiac glycosides with these drugs. Monitor serum potassium, and administer potassium supplements orally if indicated. Take drugs 1 hour before or 2 hours after herbal products. Avoid taking ashwagandha and Asian ginseng at least a week before digoxin assay... 

Taylor PJ, Mortis RG (2010) Does liquid chromatography-tandem mass spectrometry have a role in therapeutic drug monitoring of digoxin Chn Biochem 43 936-937, author reply 938... 

The effects of buspirone are decreased when the drug is administered with fluoxetine Increased serum levels of buspirone occur if the drug is taken with erythromycin or itraconazole Should any of these combinations be required, the dosage of buspirone is decreased to 2.5 mg BID, and the patient is monitored closely. Venlafaxine blood levels increase with a risk of toxicity when administered witii MAOIs or cimetidine There is an increased risk of toxicity when trazodone is administered with the phenothiazines and decreased effectiveness of trazodone when it is administered with carbamazepine Increased serum digoxin levels have occurred when digoxin is administered with trazodone There is a risk for increased phenytoin levels when phenytoin is administered witii trazodone... 

Only a small number of drug interactions have been reported with donepezil. In vitro studies show a low rate of binding of donepezil to cytochrome P-450 (CYP)3A4 or 2D6. Whether or not donepezil has the potential for enzyme induction is not known. No interactions with theophylline, cimeti-dine, warfarin, digoxin, or ketoconazole have been documented. In vitro studies show that inhibitors of CYP3A4 and 2D6 have the potential to inhibit the metabolism of donepezil. The clinical relevance of this is unknown. However, monitoring for possible increased peripheral side effects is advised... 

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