title: Evaluation of a sex-based difference in the pharmacokinetics of digoxin.
abstract: OBJECTIVE
  To determine whether a sex-based difference in digoxin pharmacokinetics exists in patients receiving long-term digoxin therapy for chronic heart failure or atrial fibrillation.
  
  
  METHODS
  Single-center, retrospective review of medical records.
  
  
  METHODS
  University-based teaching hospital and outpatient clinic.
  
  
  METHODS
  Sixty-seven adults (32 men, 35 women) with chronic heart failure or atrial fibrillation who were receiving digoxin therapy.
  
  
  RESULTS
  Serum digoxin concentrations and daily digoxin doses were obtained from patients' medical records. Daily doses were adjusted for patients' actual and ideal body weight and body mass index (BMI). The ratio between the serum digoxin concentration and each of the adjusted daily doses of digoxin was compared between men and women. The mean +/- SD serum digoxin concentration was 0.85 +/- 0.51 ng/ml for men compared with 1.02 +/- 0.51 ng/ml for women. Mean +/- SD unadjusted doses of digoxin were 0.180 +/- 0.063 and 0.164 +/- 0.059 mg/day for men and women, respectively; the difference was not statistically significant. Ratios of serum digoxin concentration to daily digoxin doses did not differ by sex when doses were estimated with actual or ideal weight. Only the ratio of the digoxin concentration to the BMI-adjusted dose was significantly different between men and women (0.14 +/- 0.09 and 0.19 +/- 0.11, respectively, p<0.05).
  
  
  CONCLUSIONS
  Sex-based differences in digoxin pharmacokinetics were absent when actual or ideal body weight was used. However, the ratio of serum digoxin concentration to daily digoxin dose adjusted for BMI differed by sex. Because digoxin is distributed to lean body mass, use of the BMI could have overadjusted body weight, leading to inaccurate pharmacokinetic assumptions and calculations. The pharmacokinetics of digoxin do not appear to differ by sex.
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Lois S
authors.initials: LS
authors.lastname: Lee
authors.forename: Lingtak-Neander
authors.initials: LN
authors.lastname: Chan
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000378:metabolism; D015992:Body Mass Index; D001835:Body Weight; D002316:Cardiotonic Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D004077:Digoxin / Q000493:pharmacokinetics* / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012727:Sex Characteristics
chemical_list: D002316:Cardiotonic Agents; D004077:Digoxin