Altered distribution of digoxin in renal failure--a cause of digoxin toxicity?
Three cases are described in which renal failure was accompanied by a lowered apparent volume of distribution of digoxin. In two cases this resulted in frank digoxin toxicity and in one equivocal toxicity. In all three cases digoxin plasma levels were greater than 2 ng/ml. The possible causes of the abnormal distribution of digoxin in renal failure are discussed. Recommendations are outlined for the use of digoxin in patients with renal failure aimed at circumventing the problem raised by a lowered apparent volume of distribution of the drug.
MRC Unit and University Department of Clinical Pharmacology, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE.
J K
JK
Aronson
D G
DG
Grahame-Smith
D002316:Cardiotonic Agents / Q000493:pharmacokinetics*; D004077:Digoxin / Q000493:pharmacokinetics* / Q000633:toxicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000378:metabolism*; D000254:Sodium-Potassium-Exchanging ATPase / Q000037:antagonists & inhibitors / Q000378:metabolism
D002316:Cardiotonic Agents; D004077:Digoxin; D000254:Sodium-Potassium-Exchanging ATPase