Appropriate pharmacokinetic parameters for designing the dosage regimen of digoxin in Thai patients
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Abstract
Digoxin is a cardiac glycoside which one of the most frequently prescribed drug, especially in the treatment of atrial fibrillation and congestive heart failure. The drug has narrow therapeutic index, complicate pharmacokinetics and the dose relates to toxicity. This study was analytical retrospective study which use the parameters from pharmacokinetic parameters in Thai population at Queen Sirikit Heart Center and Srinakarind Hospital, Khon Kaen, in previous study such as CL/F (L/h) = 0.122*CrCL, Ke (-1hr) = 1.93 and Vd/F (L) = 403, compared with the general parameters for designing appropriate regimen of digoxin in Thai patients. The study performed in 51 Thai patients, 127 digoxin blood samples, which the aged of 20-65 years old with serum creatinine levels (SCr). The concentrations calculated from the two types of parameters were compared. The result found that the serum concentrations calculated from population pharmacokinetic parameters in Thai patient could estimate more accurate than calculated from general parameters (MSE 1.01 and 1.85, respectively). Moreover, The 36 of 51 patients had creatinine clearance (CrCL) in the range of 33.38-86.70 ml/min were found that the estimated concentrations were closer to the measured concentrations. In 36 patients (83 samples) were more accurate than total of 51 patients used parameters from population pharmacokinetics and parameters from general study (MSE = 0.89, 1.01 and 1.53, respectively). The finding was concluded that the parameters from population pharmacokinetics in Thai patients could be used to calculate serum concentration at steady state (Css), estimated loading dose (LD) and maintenance dose (MD) more accurate than the general parameters especially in Thai patients who had the characteristics of diagnosed cardiac disease, 20-65 years old, measured serum creatinine and CrCL range of 33.38 - 86.70 ml/min.
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