BACKGROUND: We evaluated the Vitros 950 (Johnson & Johnson Clinical Diagnostics, Inc., NY, USA) in the measurement of digoxin and theophylline levels and compared its results to those of the TDxFLx II (Abbott Laboratories, IL, USA) used for therapeutic drug monitoring (TDM) world-widely in order to assess the utility of the Vitros 950 as a TDM instrument. METHODS: From June 1997 to August 1997, 125 and 135 candidates for TDM were randomly chosen to measure digoxin and theophylline, respectively, using the Vitros 950 and TDxFLx II. The relationship between its results and those of TDxFLx II were determined. The within-run and between-run precisions of the Vitros 950 were determined using two controls (Vitros Performance Verifier I and II; J & J Clinical Diagnostics, Inc., NY, USA). The high-concentration control (Vitros Performance Verifier II) was diluted in Vitros 7% BSA to 5 dilutions. And linearity for quantitative analysis of digoxin and theophylline were determined. RESULTS: The coefficients of variation (CV) for the within-run of the Vitro 950 were 0.8% - 4.4%. And the CV for between-run precision of the Vitro 950 were 1.7% - 12.3%. The linearity of digoxin and theophylline were relatively good. The correlations (r) of digoxin and theophylline levels with those determined by the Abbott TDxFLx II were 0.95 and 0.93, respectively (P <0.001). CONCLUSIONS: The recently developed dry slide method of the Vitros 950 proves to good precision and linearity for quantitative analysis of digoxin and theophylline. Its results correlate well with those of the TDxFLx II. The Vitros 950 does not require an elaborate preparatory protocol for the sample, and is easy to use and maintain.So it is considered a highly feasible instrument for stat test.
Digoxin* ; Drug Monitoring ; Theophylline*

No abstract available.
Digoxin* ; Reserpine* ; Tachycardia*

No abstract available.
Digoxin* ; Ear* ; Inflammation* ; Skin*

We experienced a rare clinical manifestation of a digoxin induced catatonic stupor without other features of digoxin toxicity. This case suggests that the neurological manifestation of digoxin toxicity can occur without the usual side effects. Also, a serum digoxin level should be checked in any elderly patient presenting with abnormal cerebral func-tions, irrespective of whether or not the dose of digoxin has been changed. (J Korean Neurol Assoc 19(4):438~439, 2001)
Aged ; Digoxin ; Humans ; Neurologic Manifestations ; Stupor*

BACKGROUND: Therapeutic drug monitoring (TDM) has been shown to be effective in minimizing the risk for toxicity and maximizing the efficacy of the drugs. The application of pharmacokinetics principles to indiviualization and optimization of dosage is necessary. We evolved interpretative report system of digoxin determination in a view of individual's pharmacokinetics. The alto of the present study is to validate the effectiveness of the interpretative report system in digoxin therapeutic monitoring service. METHODS: We reviewed 125 inpatients of two groups. 4 group, before interpretative reporting, had 86 inpatients from February 1996 to March 1996. B group included 39 inpatients from September 1996 to October 1996 after the practice of the sytem. Digoxin concentrations were measured in serum by TDxFlex (Abbott Laboratories, U.S.A.). Each patient's digoxin pharmacokinetics was determined by using the Abbott-base Pharmacokinetics system (Abbott Laboratories, U.S.A.) . The interpretation for the assayed digoxin level, the recommendation of maintenance dosage and the simulation graph with predicted serum levels were included in the report. The effectiveness of the reporting system was evaluated by comparing the appropriateness of digoxin level measurement between both groups. RESULTS: It revealed that appropriate measurements of digoxin level were 59.5 % of the tests in A group and 77.1% of those in B group (p=0.006). Evaluation of serum digoxin concentrations stratified by digoxin concentration showed also significant difference among the percentage of tests in each concentration range between both groups (p=0.011). CONCLUSIONS: Interpretative report system for the assayed results caused to increase in the appropriateness of digoxin measurement. The report system with some improvement which is achieved through the active approach to physician helps us use TDM effectively. The system can be applied to the other TDM drugs.
Digoxin ; Drug Monitoring* ; Humans ; Inpatients ; Pharmacokinetics

BACKGROUND: Therapeutic drug monitoring (TDM) has been shown to be effective in minimizing the risk for toxicity and maximizing the efficacy of the drugs. The application of pharmacokinetics principles to indiviualization and optimization of dosage is necessary. We evolved interpretative report system of digoxin determination in a view of individual's pharmacokinetics. The alto of the present study is to validate the effectiveness of the interpretative report system in digoxin therapeutic monitoring service. METHODS: We reviewed 125 inpatients of two groups. 4 group, before interpretative reporting, had 86 inpatients from February 1996 to March 1996. B group included 39 inpatients from September 1996 to October 1996 after the practice of the sytem. Digoxin concentrations were measured in serum by TDxFlex (Abbott Laboratories, U.S.A.). Each patient's digoxin pharmacokinetics was determined by using the Abbott-base Pharmacokinetics system (Abbott Laboratories, U.S.A.) . The interpretation for the assayed digoxin level, the recommendation of maintenance dosage and the simulation graph with predicted serum levels were included in the report. The effectiveness of the reporting system was evaluated by comparing the appropriateness of digoxin level measurement between both groups. RESULTS: It revealed that appropriate measurements of digoxin level were 59.5 % of the tests in A group and 77.1% of those in B group (p=0.006). Evaluation of serum digoxin concentrations stratified by digoxin concentration showed also significant difference among the percentage of tests in each concentration range between both groups (p=0.011). CONCLUSIONS: Interpretative report system for the assayed results caused to increase in the appropriateness of digoxin measurement. The report system with some improvement which is achieved through the active approach to physician helps us use TDM effectively. The system can be applied to the other TDM drugs.
Digoxin ; Drug Monitoring* ; Humans ; Inpatients ; Pharmacokinetics

For the purpose of elucidating relation between red cell electrolyte concentrations and serum digoxin level, measurement of red cell electrolyte concentrations and seum digoxin level by radioimmunoassay were done in 46 normal controls and 63 patients of CHF including 8 patients with digitalis intoxication. The results obtained were as follows: 1. Red cell sodium concentration and ratio of red cell sodium to red cell potassium concentration in normal males were significantly higher than those of females, and red cell potassium concentration in normal males was significantly lower than that of normal females. 2. Red cell potassium concentration in patients of CHF was significantly higher than that of normal controls, but there was no difference in the red cell sodium concentration between the groups. 3. There was no relation between red cell electrolyte concentrations and serum digoxin level, and red cell electrolyte concentration did not exactly estimate serum digoxin level. 4. Red cell electrolyte concentrations in the patient of CHF were valuable in detecting digitalis toxicity.
Digitalis ; Digoxin* ; Female ; Humans ; Male ; Potassium ; Radioimmunoassay ; Sodium

24-hour ambulatory ECG monitoring has been examined for the evaluation of heart rate and longest pause in 34 patients with chronic atrial fibrillation (20 patients treated with digoxin and 14 patients without treatment). Following results were obtained: 1. In 34 patients, the mean of average heart rates was 75.7±13.8/minute, fastest heart rates 148.0±32.4/minute, slowest heart rates 48.1±8.4/minute, difference between fastest and slowest heart rates in individual patients 99.9±29.0/minute and longest pauses 2.95±1.06seconds. The longest pauses of more than 4.0 seconds occurred in 4 of the 34 patients and made an exception of comparison groups. 2. In 27 of the 34 patients, ventricular premature contractures were developed and in 11 of 27, mainly occurred less than 100/24 hours and aberrant conduction occurred in all patients. 3. In 20 patients treated with digoxin (0.25 mg/day), the mean of average heart rates was 78.4±13.7/minute, fastest heart rates 152.5±33.1/minute, slowest heart rates 48.9±8.5/minute, difference between fastest and slowest heart rates in individual patients 103.6±31.7/minute and longest pauses 2.55±0.50 seconds. 4. In 10 patients without treatment, the mean of average heart rates was 78.0±10.7/minute, fastest heart rates 154.5±26.8/minute, slowest heart rates 50.6±7.1/minute, difference between fastest and slowest heart rates in individual patients 103.9±22.2/minute and longest pauses 2.66±0.39 seconds. 5. The difference of heart rates and longest pauses between patients with treatment and without treatment were statistically not significant (P>0.05). In summary, authors seemed to consider that 24-hour ambulatory ECG was useful and safe method for clinical evaluation of patients with chronic atrial fibrillation.
Atrial Fibrillation* ; Contracture ; Digoxin ; Electrocardiography* ; Heart Rate ; Humans ; Methods

As the Therapeutic Drug Monitoring Subcommittee (TDMS) of the Korean Association of Quality Assurance for Clinical Laboratories (KAQACL), we organised two trials as an external quality assessment of therapeutic drug monitoring (TDM) and testing for drugs of abuse (DOA) in 2014. In each trial, low and high level control materials for TDM testing, and positive and negative control materials for DOA testing, were requested from institutions. The number of participating laboratories was 107 for the first trial and 106 for the second. The average number of drug items provided was 5.7 per institution. The most commonly tested substances were, in descending order, valproic acid, digoxin, tacrolimus, phenytoin, and vancomycin. The mean inter-laboratory coefficients of variation for low- and high-level TDM control materials were 8.5% and 7.2%, respectively. The most widely used TDM analysers were the Architect i System (Abbott Diagnostics, USA), followed by the Cobas Integra (Roche Diagnostics, Switzerland) and the Cobas c501 analyser (Roche Diagnostics). The number of participating laboratories for DOA testing was 23% higher that than in 2013. In 96.9% of cases, our analysis confirmed the suitability of the tests at participating DOA laboratories in both trials. In the external quality assessment of TDM by the TDMS of KAQACL in 2014, the overall performance of TDM testing was found to be similar to that observed in the previous years, and inter-laboratory precision was higher than that in 2013. Continuous quality improvement of TDM testing by participation in a proficiency-testing program is necessary.
Digoxin ; Drug Monitoring* ; Korea ; Laboratory Proficiency Testing ; Phenytoin ; Quality Improvement ; Street Drugs* ; Tacrolimus ; Valproic Acid ; Vancomycin

Since profound hyperkalemia induces fatal arrhythmias, the recognition of its electrocardiographic manifestations is very important. The changes on the ECG correlated roughly with the severity of hyperkalemia. It has been, however, less recognized that severe hyperkalemia is associated with bradycardia. We present 14 patients with chronic kidney disease manifesting marked bradycardia in the presence or absence of hyperkalemia. It is interesting that diabetes mellitus which was complicated in 10 of 14 patients in the present study might exaggerate bradycardia with or without hyperkalemia. 9 patients, who were taking drugs such as diltiazem, beta-blocker, alpha, beta-blocker, and digoxin, developed bradycardia even when their plasma potassium concentration were moderate (<6.5 mEq/L). Therefore, we suggest that synergistic action of these drugs, hyperkalemia, diabetes mellitus, and uremic toxin in patient with chronic kidney disease might play a role in inducing bradycardia.
Arrhythmias, Cardiac ; Bradycardia* ; Diabetes Mellitus ; Digoxin ; Diltiazem ; Electrocardiography ; Humans ; Hyperkalemia ; Plasma ; Potassium ; Renal Insufficiency, Chronic*