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GONZALEZ LF, LAYNE EC. Studies on tritum-labeled digoxin: tissue, blood and urine determinations. J Clin Invest 1998; 39:1578-83. [PMID: 13706930 PMCID: PMC441894 DOI: 10.1172/jci104179] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Smith TW. Contribution of quantitative assay technics to the understanding of the clinical pharmacology of digitalis. Circulation 1972; 46:188-99. [PMID: 4261090 DOI: 10.1161/01.cir.46.1.188] [Citation(s) in RCA: 46] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Despite recent advances in understanding of the pharmacokinetics and electrophysiologic effects of cardiac glycosides, digitalis toxicity remains distressingly common in clinical practice. Another substantial group of patients is markedly underdigitalized, failing to gain the full therapeutic benefits of optimal use of these drugs. Since cardiac digitalis toxicity is a dose-related phenomenon, and serum or plasma digoxin and digitoxin concentrations rise with increasing doses, at least a statistical correlation between circulating levels and clinical state might be expected. Increasing availability of serum or plasma digitalis concentration measurements thus offers the clinician a potential means of improving the patient's chances of benefiting from treatment with cardiac glycosides. Assay methods in current use include a double-isotope dilution derivative method (digitoxin), red cell
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Rb-uptake inhibition (digitoxin and digoxin), Na
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-K
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ATPase inhibition (digitoxin), ATPase enzymatic displacement (digitoxin and digoxin), gas chromatography (digoxin), and radioimmunoassay (digitoxin, digoxin, and ouabain).
The rapidly expanding literature reporting clinical experience with these technics reflects general agreement that mean serum or plasma digoxini and digitoxin levels are significantly higher in patients with clinical evidence of toxicity compared with nontoxic patients. Nevertheless, multiple factors influence individual responses, and blood level data must be interpreted in the overall clinical context. Hypokalemia, hypercalcemia, hypomagnesemia, acid-base disturbances, hypoxemia, and hypothyroidism all tend to decrease tolerance to any given digitalis dose or blood level. Autonomic nervous system tone and other drugs concurrently received must also be considered. Advanced heart disease in general, and coronary artery disease in particular, appear to predispose patients to apparent digitalis toxicity at relatively lower serum or plasma levels.
Cardiac glycoside assay technics have also proven useful in various studies of the clinical pharmacology of digoxin, digitoxin, and ouabain. Handling of digoxin by patients on cardiopulmonary bypass has been assessed, and gastrointestinal absorption has been evaluated in normal subjects; poor and erratic absorption of the drug has been documented in patients with malabsorption syndromes. Potentially important drug-drug interactions of agents such as phenobarbital and phenylbutazone with digitoxin have been studied, as well as the effects of steroid-binding resins on digoxin and digitoxin metabolism. Studies of ouabain pharmacokineties by radioimmunoassay have demonstrated a plasma half-life of 21 hours, indicating that, as in the case of digoxin and digitoxin, half-life of serum or plasma concentration after establishment of blood-tissue equilibrium bears a close relationship to duration of clinical effect.
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Jackson DM. The occurrence and distribution in blood of -phenylethylamine in association with cardiac disease. COMPARATIVE AND GENERAL PHARMACOLOGY 1970; 1:263-72. [PMID: 5527563 DOI: 10.1016/0010-4035(70)90019-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Ruiz-Torres A. [Kinetics of cardiac steroids in man and experimental animals]. KLINISCHE WOCHENSCHRIFT 1970; 48:257-70. [PMID: 4943080 DOI: 10.1007/bf01486434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Lukas DA, Peterson RE. Double isotope dilution derivative assay of digitoxin in plasma, urine, and stool of patients maintained on the drug. J Clin Invest 1966; 45:782-95. [PMID: 5935363 PMCID: PMC292755 DOI: 10.1172/jci105393] [Citation(s) in RCA: 97] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Arterielle Konzentration, arterio-ven�se Differenz im Coronarblut und Organverteilung von C14-markiertem Lanatosid C nach rascher intraven�ser Injektion. Naunyn Schmiedebergs Arch Pharmacol 1962. [DOI: 10.1007/bf00738219] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
By means of the embryonic duck heart preparation, both lanatoside C. and digitoxin could be detected and quantitatively measured in the sera of rats after parenteral administration of both drugs. A study of the behavior of the two glycosides in blood indicated that a striking difference existed in the respective rates of disappearance of both drugs from the bloodstream.
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