Serdar Olt, Mustafa Selçuk, Ayşe Tutak, Fatma Akbaş, Orhan Öznas

ÖZGÜN MAKALE/ORIGINAL ARTICLE

Amaç: Bu çalışmanın amacı terapötik seviyede digoksin seviyesi olan hastalarda digoksin toksisitesi ve risk faktörlerini araştırmak. Metot: Başvuru sırasında digoksin seviyesi 1,4 ng/mL’nin üzerinde ve 2,0 ng/mL’nin altında olan 95 hasta klinik belirti ve elektrokardiyografi kayıtları göz önüne alınarak toksisite olan ve toksisite olmayan olarak iki gruba ayrıldı. Klinik ve laboratuar verileri iki grup arasında karşılaştırıldı. Bulgular: Tüm hastalar digoksin kullanma endikasyonu açısından değerlendirildiğinde 56 hasta (58,9%) sadece sol kalp yetersizliği, 32 hasta (33,6%) atriyal fibrilasyon ve 20 hasta (21%) her iki durum için kullanıyorlardı. 17 hastada (17,9%) ise digoksin kullanımının net bir nedeni, bulunamadı. Toksik ve toksik olmayan grup arasında yaş, cinsiyet, koroner arter hastalığı dışındaki medikal öykü ve laboratuar bulguları açısından fark yoktu. Sadece koroner arter hastalığı öyküsü anlamlı şekilde toksik grupta fazla saptandı (p:0,008). Atriyal fibrilasyon (p

Anahtar Kelimeler:

Digoksin, toksisite, intoksikasyon, serum digoksin düzeyleri

DIGOXIN TOXICITY IN THERAPEUTIC SERUM LEVELS

Aim:The purpose of this study, to evaluate digoxin toxicity and risk factors leading to digoxin toxicity in patients with therapeutic digoxin levels.Material and Methods: We studied ninety–five patients with digoxin level was above of the 1.4 ng/mL and below of the 2.0 ng/mL at admission. They were divided into two groups, drug toxicity or nontoxicity, on the basis of both clinical symptoms and electrocardiography recording. The clinical and laboratory data were compared between these groups.Results: When overall patients’ digoxin usage indications were evaluated, it was revealed that 56 patients (58.9%) had been received digoxin only for heart failure, 32 patients (33.6%) only for atrial fibrillation and 20 patients (21%) received digoxin for both conditions. The exact reason for digoxin usage could not be determined in 17 patients (17.9%). When patients were evaluated, no differences in age, gender, medical history other than coronary artery disease and laboratory findings were observed between toxic and nontoxic patients. The medical history of coronary artery disease in toxic patients was significantly higher than in nontoxic patients (p: 0.008). In these variable, no differences were observed except atrial fibrillation (p<0.001), between toxic and nontoxic patients.Conclusion: In this study, the exact reasons for digoxin use could not be determined in 17 (17.9%) patients. In appropriate usage of digoxin could be increased risk of adverse outcomes and education program may reduce in appropriate use. Clinicians should be aware that signs of toxicity may occur at levels below of the 2.0 ng/mL, and such toxicity is more likely in the presence of atrial fibrillation or coronary artery disease.Keywords: Digoxin, toxicity, intoxication, serum digoxin levels

Keywords:

Digoxin, toxicity, intoxication, serum digoxin levels,

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Uretsky BF, Young JB, Shahidi FE, Yellen LG, Harrison MC, Jolly MK. Randomized study assessing the effect of digoxin withdrawal in patients with mild to moderate chronic congestive heart failure: results of the PROVED trial. PROVED Investigative Group. J Am CollCardiol 1993; 22: 955-62.
Packer M, Gheorghiade M, Young JB, Costantini PJ, Adams KF, Cody RJ, et al. Withdrawal of digoxin from patients with chronic heart failure treated with angiotensin-converting-enzyme inhibitors. RADIANCE Study. N Engl J Med 1993; 329: 1-7.
The effect of digoxin on mortality and morbidity in patients with heart failure. The Digitalis Investigation Group. N Engl J Med 1997; 336: 525-33.
Ahmed A, Rich MW, Love TE, Lloyd-Jones DM, Aban IB, Colucci WS, et al. Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial. Eur Heart J 2006; 27: 178-86.
Gheorghiade M, Braunwald E. Reconsidering the role for digoxin in the management of acute heart failure syndromes. Jama 2009; 302: 2146-7.
Hussain Z, Swindle J, Hauptman PJ. Digoxin use and digoxin toxicity in the post-DIG trial era. J Card Fail 2006; 12: 343-6.
See I, Shehab N, Kegler SR, Laskar SR, Budnitz DS. Emergency department visits and hospitalizations for digoxin toxicity: United States, 2005 to 2010. Circ Heart Fail 2014; 7: 28-34.
Miura T, Kojima R, Sugiura Y, Mizutani M, Takatsu F, Suzuki Y. Effect of aging on the incidence of digoxin toxicity. Ann Pharmacother 2000; 34: 427-32
JS B, MA K. Tintinalli's Emergency Medicine, A Comprehensive Study Guide. In Digitalis Glycosides, ed. T J, pp. 1260-4. New York: McGraw Hill; 2010.
Kirilmaz B, Saygi S, Gungor H, Onsel Turk U, Alioglu E, Akyuz S, Asgun F, Tengiz I, Ercan E. Digoxin intoxication: An old enemy in modern era. J Geriatr Cardiol 2012; 9: 237-42.
Borron SW, Bismuth C, Muszynski J. Advances in the management of digoxin toxicity in the older patient. Drugs Aging 1997; 10: 18-33.
Passmore AP, Johnston GD. Digoxin toxicity in the aged. Characterising and avoiding the problem. Drugs Aging 1991; 1: 364-79.
Gheorghiade M, Adams KF, Jr., Colucci WS. Digoxin in the management of cardiovascular disorders. Circulation 2004; 109: 2959-64.
Beller GA, Conroy J, Smith TW. Ischemia-induced alterations in myocardial (Na+ + K+)-ATPase and cardiac glycoside binding. J Clin Invest 1976; 57: 341-50.
Whitbeck MG, Charnigo RJ, Khairy P, Ziada K, Bailey AL, Zegarra MM, et al. Increased mortality among patients taking digoxin--analysis from the AFFIRM study. Eur Heart J 2013; 34: 1481-8.
Corley SD, Epstein AE, DiMarco JP, Domanski MJ, Geller N, Greene HL, et al. Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study. Circulation 2004; 109: 1509-13.
Biteker M, Duman D, Dayan A, Can MM, Tekkesin AI. Inappropriate use of digoxin in elderly patients presenting to an outpatient cardiology clinic of a tertiary hospital in Turkey. Turk Kardiyol Dern Ars 2011; 39: 365-70.