Individual dosage of digoxin in patients with heart failure.
BACKGROUND
After the publication of DIG trial, the therapeutic target of serum digoxin concentration (SDC) for the treatment of heart failure (HF) has been lowered (0.40-1.00 ng/ml). However, the majority of equations to calculate digoxin dosages were developed for higher SDCs. Recently, a new equation was validated in Asian population for low SDCs by Konishi et al., but results in Caucasians are unknown.


OBJECTIVE
This study was aimed to test the Konishi equation in Caucasians specifically targeting low SDCs. Furthermore, the Konishi equation was compared with other frequently used equations.


METHODS
This was a prospective, multicenter study.


METHODS
Clinically indicated digoxin was given in 40 HF patients. The dosage was calculated with the Konishi equation. The SDC was measured at 1 and 6 months after starting digoxin. Adherence to digoxin was monitored with a specific questionnaire.


RESULTS
After exclusion of patients admitting poor adherence, we found a reasonable correlation between predicted and measured SDC (r=0.48; P<0.01) by the Konishi equation. Excluding patients with poor adherence and relevant worsening of renal function, the measured SDC (n=54 measurements) was within the pre-defined therapeutic range in 95% of the cases. The mean, maximal and minimal measured SDC were 0.69±0.19, 1.00 and 0.32 ng/ml, respectively. The correlation was weaker for the Jelliffe, the Koup and Jusko, and the Bauman equations.


CONCLUSIONS
This study supports the clinical validity of the Konishi equation for calculating individual digoxin dosage in Caucasians, targeting SDCs according to current HF guidelines.
Cardiology Department, University Hospital Basel, and Department of Cardiology, University of Basel, Petersgraben 4, 4031 Basel, Switzerland. muzzarellis@uhbs.ch
S
S
Muzzarelli
H
H
Stricker
O
O
Pfister
P
P
Foglia
G
G
Moschovitis
G
G
Mombelli
H
H
Brunner-La Rocca
D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D004077:Digoxin / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D016896:Treatment Outcome; D044465:White People
D002316:Cardiotonic Agents; D004077:Digoxin