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Sara A. I. Eltayeb* and Dr. Alnada A. M. Ibrahim


Background: Digoxin therapy requires close monitoring and proper handling because of its narrow therapeutic index and the wide variety of factors that affect digoxin serum level. Objective: This review attempts to examine papers that address why, when and how therapeutic drug monitoring (TDM) of digoxin is usually undertaken. Method: Articles were identified electronically using the following databases: Pubmed, Trip, Web of Science, Science Direct and Medline. Search was restricted to articles published in English during the period 2001 to 2012. The identified Studies were then examined for their relevance. Only full texts, human based studies were included. Results: Sixteen studies were included based on the inclusion criteria. Three studies evaluated TDM practice of digoxin among medical group setting. Seven studies involved drugs that commonly interact with digoxin and in which interaction necessitates the monitoring process. Tow studies assessed the effect of non drug factors on digoxin serum level. One study evaluated how different immunoassay methods can give discordant results, three studies addressed renal function as a major determining factor of digoxin serum level and one study assessed the correlation between serum level and incidence of mortality. Conclusion: Digoxin monitoring should be undertaken in a response to certain indications and not as a part of routine medical practice. This process should be performed at least 8hours following the last oral dose. In addition, renal function as well as the concomitant use of p-glycoprotein inhibitor drugs is important determinants of digoxin serum level. Furthermore, this review revealed that how different immunoassay methods can lead in to different digoxin serum level and different clinical action as well. Among the difficulties that clinician might face is the negative or positive interference from drugs like canrenone, spironolactone, prednisolone and hydrocortisone, subsequently this interference can lead in to false dose adjustment.

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