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International Journal of Clinical... Aug 2001Drug-related illness is an everlasting universal problem and also an important cause of admissions to hospitals. Adverse reactions are still grossly underreported by...
Drug-related illness is an everlasting universal problem and also an important cause of admissions to hospitals. Adverse reactions are still grossly underreported by medical professions. Little information is available regarding the frequency or type of ADRs managed in hospitals. Since January 1997, we have taken part in a study, supported by the German Federal Institute for Drugs and Medical Device to improve the spontaneous drug information reporting system in Germany. Three German regionalized Departments of Clinical Pharmacology--Jena, Dresden, Rostock--serve as Pharmacovigilance Centers in collaboration with the Pharmacoepidemiology Research Group of the University of Munich. Since January 1997, the regional group in Jena has been monitoring the University Clinic of Internal Medicine for admissions caused by adverse drug reactions. All emergency cases and patients on intensive care units were checked for adverse drug reactions. We present our results, including clinical and demographic data, concerning intoxications and especially those involving digitoxin in 210 patients with ADR. Forty patients with digitoxin toxicity had an average age of 81 years (81.1+/-6.3), a low body weight (59.7+/-12.7 kg) and 3 out of 4 were women. 75% of all patients with digitoxin side effects had elevated serum digitoxin levels with concentrations higher than 25 microg/ml. The relatively high frequency of digitoxin intoxications in our hospital may reflect the advanced age and low body weight of patients. Patients received digitoxin regardless of age, weight and, sometimes, clinical indication. Physicians should be aware of drugs having a high risk when used in elderly patients. The use of digitoxin assays and keeping serum levels within or near the therapeutic range will diminish the incidence of overdoses.
Topics: Adverse Drug Reaction Reporting Systems; Age Factors; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Demography; Digitoxin; Drug Overdose; Female; Germany; Hospitalization; Humans; Male; Risk Factors
PubMed: 11515708
DOI: 10.5414/cpp39336 -
Klinische Wochenschrift Jan 1973
Review
Topics: Adenosine Triphosphatases; Age Factors; Chromatography, Gas; Digitoxin; Digoxin; Humans; Methods; Potassium; Radioimmunoassay; Radioisotope Dilution Technique; Rubidium; Sodium
PubMed: 4265573
DOI: 10.1007/BF01467756 -
Annals of Internal Medicine Apr 1970
Topics: Atrial Fibrillation; Creatinine; Digitoxin; Digoxin; Dosage Forms; Glycosides; Heart Rate; Humans; Intestinal Absorption; Kidney; Kinetics; Liver; Thyroid Gland; Time Factors; Water-Electrolyte Balance
PubMed: 5437627
DOI: 10.7326/0003-4819-72-4-453 -
The Journal of Pharmacology and... Dec 1966
Topics: Animals; Bile; Biotransformation; Chromatography, Paper; Digitoxin; Digoxin; Dogs; Feces
PubMed: 5928256
DOI: No ID Found -
Clinica Chimica Acta; International... Mar 2001Traditional Chinese medicines are readily available without prescription from herbal drug stores. One such Chinese medicine, Chan Su, which is prepared from the skin...
Digitoxin-like immunoreactivity in sera of mice after feeding with chinese medicine Chan Su: study of protein binding of Chan Su in normal sera, uremic sera and sera from patients with liver disease.
Traditional Chinese medicines are readily available without prescription from herbal drug stores. One such Chinese medicine, Chan Su, which is prepared from the skin gland of toads, has cardiotonic effect due to bufadienolides. Here we report rapid detection of the presence of Chan Su in blood using the fluorescence polarization immunoassay for digitoxin. In our study mice were fed with a dose of 75 mg/kg of Chan Su and blood was drawn before, and 1 and 2 h after feeding. We observed significant digitoxin-like immunoreactivity in the sera. For example in one mouse the digitoxin-like immunoreactivity was undetectable before feeding with Chan Su, but was 19.7 ng/ml 1 h and 8.8 ng/ml 2 h afterwards. The apparent half-life of Chan Su is approximately 1 h in mice. In another experiment, we studied protein binding of Chan Su by measuring total and free Chan Su concentrations (ultrafiltrate prepared by using Centrifree Micropartition Filter, molecular weight cutoff: 30000 Da). Chan Su was strongly bound to serum proteins. We observed higher free fraction in uremic sera and sera from patients with liver disease. We identified albumin as one of the proteins that bind Chan Su in serum.
Topics: Animals; Bufanolides; Digitoxin; Liver Diseases; Mice; Uremia
PubMed: 11249936
DOI: 10.1016/s0009-8981(01)00377-1 -
Deutsches Arzteblatt International Apr 2018
Topics: Digitoxin
PubMed: 29739499
DOI: 10.3238/arztebl.2018.0285b -
Age and Ageing Mar 1998The digitoxin half-life in elderly patients in the eight and ninth decade was more prolonged (mean +/- SD: 25 +/- 9 days) than in younger people (6.7 +/- 1.7). These...
The digitoxin half-life in elderly patients in the eight and ninth decade was more prolonged (mean +/- SD: 25 +/- 9 days) than in younger people (6.7 +/- 1.7). These elderly patients accumulated digitoxin even on a dose of 0.05 mg/ day. The symptoms of digitoxin intoxication disappeared on discontinuation of medication. When digitoxin is used in the treatment for heart failure in the very elderly patients, one should be aware of the possibility of digitoxin intoxication, even on a low dose.
Topics: Aged, 80 and over; Aging; Cardiotonic Agents; Digitoxin; Heart Failure; Humans
PubMed: 16296683
DOI: 10.1093/ageing/27.2.222 -
European Heart Journal Jan 1989Following chronic oral administration of digitoxin 0.1 mg day-1 the pharmacokinetics of this glycoside were studied in seven patients with hepatorenal insufficiency and...
Following chronic oral administration of digitoxin 0.1 mg day-1 the pharmacokinetics of this glycoside were studied in seven patients with hepatorenal insufficiency and were compared with those of seven healthy volunteers. Liver cirrhosis of the patients was confirmed by liver biopsy. Mean creatinine clearance of the healthy subjects was 129.7 +/- 3.3 ml min-1 (mean +/- SEM), that of the patients was 25.6 +/- 20.4 ml min-1. Mean antipyrine clearance (parameter of oxidative liver function) was 49.7 +/- 6.0 ml min-1 in the volunteers and 22.0 +/- 2.9 ml min-1 in the patients. Plasma protein binding of digitoxin (PPB) was 95.0 +/- 1.1% in the patients and 96.7 +/- 0.6% in the healthy subjects (n.s.). Total body clearance of digitoxin (Cltot) was 0.0728 +/- 0.0120 ml min-1 kg-1 in the patients and 0.0615 +/- 0.0027 ml min-1 kg-1 in normals (n.s.]. Mean steady state plasma levels (Css) of the patients were 18.3 +/- 4.7 ng ml-1 and 15.8 +/- 1.3 ng ml-1 in the normals (n.s.). Our data obtained from chronic oral administration do not indicate a reduced total body clearance of digitoxin in patients with hepatorenal insufficiency.
Topics: Administration, Oral; Adult; Aged; Digitoxin; Female; Hepatorenal Syndrome; Humans; Kidney Diseases; Liver Cirrhosis; Male; Middle Aged
PubMed: 2702965
DOI: 10.1093/oxfordjournals.eurheartj.a059379 -
Cardiology 2014
Topics: Digitalis; Digitoxin; Famous Persons; Heart Failure; History, 18th Century; History, 19th Century; Humans; Medicine in the Arts; Mental Disorders; Paintings; Phytotherapy; Plant Preparations
PubMed: 24401658
DOI: 10.1159/000355335 -
Biochemia Medica 2012Two Italian adults arrived at the Emergency Department referring diarrhea, nausea and vomiting for 4 days; weakness, fatigue and visual hallucinations were also...
INTRODUCTION
Two Italian adults arrived at the Emergency Department referring diarrhea, nausea and vomiting for 4 days; weakness, fatigue and visual hallucinations were also complained of. Patients reported the ingestion of some leaves of a plant, which they supposed to be "donkey ears", a week before. Physical examination showed hypotension and bradycardia and ECG examination disclosed sinus rhythm and repolarization abnormalities (scooping of the ST-T complex) in both patients and a 2:1 AV block in the man.
MATERIALS AND METHODS
Digoxin concentration was evaluated twice for each patient (at the admission and after 4 hours) by the automated immunoassay system ADVIA Centaur. Digitoxin concentration was evaluated by liquid chromatography-mass spectrometry (LC-MS/MS).
RESULTS
Despite clinical picture was suggestive of digitalis intoxication, digoxin levels were undetectable. Due to the more severe clinical picture, the male patient was treated with anti-digoxin antibodies (Digifab) achieving a good clinical improvement and remission of the AV block within two hours. Initial diagnosis was confirmed by LC-MS/MS showing high digitoxin concentrations, but digoxin was undetectable. Patients remained stable and 48 hours later were discharged from the hospital.
CONCLUSION
Whereas digoxin determination frequently relies on monoclonal antibodies which do not cross-react to digitoxin, polyclonal antibodies constituting Digifab recognize a large spectrum of cardiac glycosides, including digitoxin. This report emphasizes the primary role of the clinical approach to patients in the emergency setting and how an active communication and a continuous sharing of professional experiences between Laboratory and Clinicians ensure an early and correct diagnosis.
Topics: Antibodies; Clinical Medicine; Digitoxin; Female; Humans; Male; Middle Aged
PubMed: 23092069
DOI: 10.11613/bm.2012.040