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A case series of 147 patients showed that not all cases of acute digoxin overdose require anti‐digoxin Fab, nor should anti‐digoxin Fab dose be calculated based on ingested dose. In contrast, a higher mortality (7.6%) was noted in a case series of acute and chronic digoxin and digitoxin poisoning despite Fab being used first line.
Kidney function gradually decreases as someone ages. The elderly are also likely to be underweight. In addition, these older people tend to be dehydrated and be taking other medications. These factors increase the likelihood of developing side effects of digoxin and digoxin toxicity. Often lowering the dose is considered by the prescriber. [6]
In pharmacokinetics, a loading dose is an initial higher dose of a drug that may be given at the beginning of a course of treatment before dropping down to a lower maintenance dose. [ 1 ] A loading dose is most useful for drugs that are eliminated from the body relatively slowly, i.e. have a long systemic half-life .
Digoxin increased the risk of death in women by 23%. There was no difference in the death rate for men in the study. [38] Digoxin is also used as a standard control substance to test for P-glycoprotein inhibition. [39] Digoxin appears to be a peripherally selective drug due to limited brain uptake caused by binding to P-glycoprotein. [40] [41]
A dose of 400 mg is used in digoxin poisoning, but a dose of 800 mg is recommended for oleandrin poisoning due to the lower binding affinity of the antibody to oleandrin. [ 22 ] [ 23 ] Patients receiving an adequate dose of anti-digoxin Fab show a good response, resolving serious arrhythmias in two hours in fifty percent of the cases.
Therefore, the dose required to give a certain plasma concentration can be determined if the V D for that drug is known. The V D is not a physiological value; it is more a reflection of how a drug will distribute throughout the body depending on several physicochemical properties, e.g. solubility, charge, size, etc.
Type A: augmented pharmacological effects, which are dose-dependent and predictable [5]; Type A reactions, which constitute approximately 80% of adverse drug reactions, are usually a consequence of the drug's primary pharmacological effect (e.g., bleeding when using the anticoagulant warfarin) or a low therapeutic index of the drug (e.g., nausea from digoxin), and they are therefore predictable.
Unlike digoxin, which is eliminated from the body via the kidneys, it is eliminated via the liver, and so can be used in patients with poor or erratic kidney function. While several controlled trials have shown digoxin to be effective in a proportion of patients treated for heart failure, the evidence base for digitoxin is not as strong ...