Key result
Estimated digoxin levels reach the toxic range in ~24% of heart failure patients.
Why the study?
Digoxin requires close monitoring to prevent toxicity in heart failure patients, but limitations in therapeutic drug monitoring exist, necessitating alternative estimation methods.
Does a pharmacokinetic formula-based approach effectively estimate digoxin toxicity risk and identify drug interactions in patients with congestive heart failure?
Observational (n=17)
No
Does a pharmacokinetic formula-based approach effectively estimate digoxin toxicity risk and identify drug interactions in patients with congestive heart failure?
Absolute Event Rate: 76% vs 24%
A formula-based pharmacokinetic approach identified that 24% of heart failure patients receiving standard-dose digoxin were at risk for toxic serum levels, demonstrating its potential utility as an initial screening tool in resource-limited settings lacking therapeutic drug monitoring.
Estimated digoxin toxicity risk in HF warrants caution with renal impairment and interactions; leaves open formula-based screening utility pending validation.
Digoxin has a narrow therapeutic index, requiring close monitoring to prevent toxicity, particularly in patients with heart failure, polypharmacy, and impaired renal function. Due to limitations in therapeutic drug monitoring (TDM), we estimated digoxin serum levels using pharmacokinetic formulas based on creatinine clearance. This retrospective observational study aimed to conduct an initial risk screening by estimating digoxin concentrations, evaluating drug interactions, and assessing heart rate in 17 heart failure patients at a regional general hospital in Jambi (January–August 2025). Descriptive analysis revealed that 76% of patients were within the therapeutic range, while 24% exceeded it, with elevated levels correlating with higher creatinine serum and lower creatinine clearance. Common drug interactions involved furosemide, bisoprolol, and proton pump inhibitors, with spironolactone posing a severe risk. Clinically, bisoprolol combined with hypokalemia appeared associated with lower heart rates in patients with predicted toxic concentrations. While the formula-based pharmacokinetic approach serves as a useful exploratory initial screening tool, these findings require further validation through laboratory-based TDM and larger studies.
No takes yet. Share an insight, caveat, or question.
Sadli et al. (2026) conducted an observational in Congestive heart failure (n=17). Digoxin therapy vs. null was evaluated on Estimated steady-state digoxin concentration (therapeutic 0.5-2 ng/mL vs toxic >2 ng/mL). Pharmacokinetic estimation of digoxin levels in heart failure patients revealed that 24% were in the toxic range, correlating with higher serum creatinine and specific drug interactions.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: