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Review: Failure of current digoxin monitoring for toxicity: new monitoring recommendations to maintain therapeutic levels for efficacy

The current recommendations for monitoring digoxin, a narrow therapeutic index drug, are limited to confirming medication use or investigating suspicion of toxicity and fail our oath to do no harm. Numerous meta-analyses evaluating digoxin use consistently recommend frequent monitoring to maintain t...

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Autores principales: Gona, Sridhar Rao, Rosenberg, Joel, Fyffe-Freil, Ria C., Kozakiewicz, Janet M., Money, Mary E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10350506/
https://www.ncbi.nlm.nih.gov/pubmed/37465455
http://dx.doi.org/10.3389/fcvm.2023.1179892
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author Gona, Sridhar Rao
Rosenberg, Joel
Fyffe-Freil, Ria C.
Kozakiewicz, Janet M.
Money, Mary E.
author_facet Gona, Sridhar Rao
Rosenberg, Joel
Fyffe-Freil, Ria C.
Kozakiewicz, Janet M.
Money, Mary E.
author_sort Gona, Sridhar Rao
collection PubMed
description The current recommendations for monitoring digoxin, a narrow therapeutic index drug, are limited to confirming medication use or investigating suspicion of toxicity and fail our oath to do no harm. Numerous meta-analyses evaluating digoxin use consistently recommend frequent monitoring to maintain the level of 0.5 to ≤1.0 ng/ml because higher levels lead to increased morbidity and mortality without benefit. Data from the United States National Poison Control Center (2012–2020) show annual deaths due to digoxin of 18–36 compared to lithium's 1–7, and warfarin's 0–2 respectively. The latter drugs also have narrow therapeutic indexes like digoxin yet are more carefully monitored. Recognition of digoxin toxicity is impaired as levels are not being routinely checked after medications are added to a patient's regimen. In addition, providers may be using ranges to guide treatment that are no longer appropriate. It is imperative that monitoring guidelines and laboratory therapeutic levels are revised to reduce morbidity and mortality due to digoxin. In this review, we provide a comprehensive literature review of digoxin monitoring guidelines, digoxin toxicity, and evidence to support revising the ranges for serum digoxin monitoring.
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spelling pubmed-103505062023-07-18 Review: Failure of current digoxin monitoring for toxicity: new monitoring recommendations to maintain therapeutic levels for efficacy Gona, Sridhar Rao Rosenberg, Joel Fyffe-Freil, Ria C. Kozakiewicz, Janet M. Money, Mary E. Front Cardiovasc Med Cardiovascular Medicine The current recommendations for monitoring digoxin, a narrow therapeutic index drug, are limited to confirming medication use or investigating suspicion of toxicity and fail our oath to do no harm. Numerous meta-analyses evaluating digoxin use consistently recommend frequent monitoring to maintain the level of 0.5 to ≤1.0 ng/ml because higher levels lead to increased morbidity and mortality without benefit. Data from the United States National Poison Control Center (2012–2020) show annual deaths due to digoxin of 18–36 compared to lithium's 1–7, and warfarin's 0–2 respectively. The latter drugs also have narrow therapeutic indexes like digoxin yet are more carefully monitored. Recognition of digoxin toxicity is impaired as levels are not being routinely checked after medications are added to a patient's regimen. In addition, providers may be using ranges to guide treatment that are no longer appropriate. It is imperative that monitoring guidelines and laboratory therapeutic levels are revised to reduce morbidity and mortality due to digoxin. In this review, we provide a comprehensive literature review of digoxin monitoring guidelines, digoxin toxicity, and evidence to support revising the ranges for serum digoxin monitoring. Frontiers Media S.A. 2023-07-03 /pmc/articles/PMC10350506/ /pubmed/37465455 http://dx.doi.org/10.3389/fcvm.2023.1179892 Text en © 2023 Gona, Rosenberg, Fyffe-Freil, Kozakiewicz and Money. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Gona, Sridhar Rao
Rosenberg, Joel
Fyffe-Freil, Ria C.
Kozakiewicz, Janet M.
Money, Mary E.
Review: Failure of current digoxin monitoring for toxicity: new monitoring recommendations to maintain therapeutic levels for efficacy
title Review: Failure of current digoxin monitoring for toxicity: new monitoring recommendations to maintain therapeutic levels for efficacy
title_full Review: Failure of current digoxin monitoring for toxicity: new monitoring recommendations to maintain therapeutic levels for efficacy
title_fullStr Review: Failure of current digoxin monitoring for toxicity: new monitoring recommendations to maintain therapeutic levels for efficacy
title_full_unstemmed Review: Failure of current digoxin monitoring for toxicity: new monitoring recommendations to maintain therapeutic levels for efficacy
title_short Review: Failure of current digoxin monitoring for toxicity: new monitoring recommendations to maintain therapeutic levels for efficacy
title_sort review: failure of current digoxin monitoring for toxicity: new monitoring recommendations to maintain therapeutic levels for efficacy
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10350506/
https://www.ncbi.nlm.nih.gov/pubmed/37465455
http://dx.doi.org/10.3389/fcvm.2023.1179892
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