title: Standards of laboratory practice: cardiac drug monitoring. National Academy of Clinical Biochemistry.
abstract: In this Standard of Laboratory Practice we recommend guidelines for therapeutic monitoring of cardiac drugs. Cardiac drugs are primarily used for treatment of angina, arrhythmias, and congestive heart failure. Digoxin, used in congestive heart failure, is widely prescribed and therapeutically monitored. Monitoring and use of antiarrhythmics such as disopyramide and lidocaine have been steadily declining. Immunoassay techniques are currently the most popular methods for measuring cardiac drugs. Several reasons make measurement of cardiac drugs in serum important: their narrow therapeutic index, similarity in clinical complications and presentation of under- and overmedicated patients, need for dosage adjustments, and confirmation of patient compliance. Monitoring may also be necessary in other circumstances, such as assessment of acetylator phenotypes. We present recommendations for measuring digoxin, quinidine, procainamide (and N-acetylprocainamide), lidocaine, and flecainide. We discuss guidelines for measuring unbound digoxin in the presence of an antidote (Fab fragments), for characterizing the impact of digoxin-like immunoreactive factor (DLIF) and other cross-reactants on immunoassays, and for moni-toring the unbound (free fraction) of drugs that bind to alpha1-acid glycoprotein. We also discuss logistic, clinical, hospital, and laboratory practice guidelines needed for implementation of a successful therapeutic drug monitoring service for cardiac drugs.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Louisville, KY 40292, USA. r0vald01@homer.louisville.edu
authors.forename: R
authors.initials: R
authors.lastname: Valdes
authors.forename: S A
authors.initials: SA
authors.lastname: Jortani
authors.forename: M
authors.initials: M
authors.lastname: Gheorghiade
mesh_terms: D000787:Angina Pectoris / Q000097:blood / Q000188:drug therapy; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000188:drug therapy; D001800:Blood Specimen Collection / Q000592:standards; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use; D002301:Cardiac Glycosides / Q000009:adverse effects / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use; D004347:Drug Interactions; D016903:Drug Monitoring / Q000592:standards*; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy; D006801:Humans; D007118:Immunoassay / Q000592:standards; D014665:Vasodilator Agents / Q000009:adverse effects / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D002121:Calcium Channel Blockers; D002301:Cardiac Glycosides; D014665:Vasodilator Agents