digoxin and Diarrhea

Numerous medications can trigger diarrhea. In some cases it is a common side effect, and the relationship is evident (e.g. acarbose, somatostatin analogs and antibiotics). When diarrhea does occur, the therapeutic benefit of the drug should be weighed against the negative results of the side effect. If pseudomembranous colitis is suspected, prompt action is required, since a fatal outcome cannot be excluded. A particular challenge is a suspected drug association in a multimorbid patient taking several drugs, each associated with an only low diarrhea risk. In such a case, it may be necessary to discontinue drugs consecutively, or to replace a drug by another, until the diarrhea ceases, without lessening the effectiveness of the treatment.

Topics: Aged; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Antihypertensive Agents; Antineoplastic Agents; Antirheumatic Agents; Cardiotonic Agents; Diarrhea; Digoxin; Drug-Related Side Effects and Adverse Reactions; Enterocolitis, Pseudomembranous; Female; Gastrointestinal Motility; Hormones; Humans; Hypoglycemic Agents; Male; Radiography, Abdominal; Ultrasonography

Topics: Adult; Biological Availability; Clinical Trials as Topic; Diarrhea; Digoxin; Humans; Male

The art of general practice is to identify important causes of common, often undifferentiated symptoms. This article presents two cases of clinical digoxin toxicity in the presence of normal or low serum digoxin levels. Standard teaching says that symptoms are related directly to toxic serum levels, but this appears to be not always the case.

Topics: Aged; Diarrhea; Digoxin; Feeding and Eating Disorders; Female; Humans; Male; Nausea

Stool specimens obtained from 77 residents of a nursing home were analysed to determine the relationship between colonisation with digoxin-reducing strains of Eubacterium lentum and infection with Clostridium difficile. Patients were categorised according to previous antibiotic treatment, prescription of enteral feedings, and pattern of bowel habits. Colonisation with digoxin-reducing E. lentum was less common in subjects infected with C. difficile, in those treated with antibiotics previously, and in those prescribed enteral feedings. Normal bowel habits were more common in those without C. difficile. The lowest incidence of diarrhoea was seen in patients without C. difficile who were colonised with digoxin-reducing species. This study establishes an inverse relationship between the presence of C. difficile and E. lentum that reduce digoxin which is related to previous treatment with antibiotics and prescription of enteral feedings. Bacterial markers may prove to be a useful tool for predicting clinical disturbances in bowel function.

Topics: Adult; Aged; Aged, 80 and over; Clostridioides difficile; Diarrhea; Digoxin; Enteral Nutrition; Enterocolitis, Pseudomembranous; Eubacterium; Female; Humans; Male; Middle Aged; Nursing Homes

Topics: Aged; Chronic Disease; Diarrhea; Digoxin; Female; Heart Failure; Humans

A study was carried out to assess the feasibility of using record linkage for drug monitoring. For two years, three types of records were collected for a total of 43 117 people: (1) details of basic attributes, such as sex and age; (2) details of prescriptions dispensed; and (3) records of hospital admissions, obstetric deliveries, and deaths. The records about each person were linked together, and analyses were performed to reveal associations between drugs and diagnoses. The study suggested that record linkage would be useful both for generating and for testing hypotheses about the adverse effects of drugs. The method would be especially valuable for detection of delayed effects (such as the induction of cancer), sudden deaths outside hospital, and effects of the fetus-all of which are difficult to study by other means. A full-scale project would need to cover a large population, and some of the practical issues that would arise are discussed.

Topics: Aged; Aspirin; Cerebral Hemorrhage; Computers; Delivery, Obstetric; Diarrhea; Digoxin; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Infant; Medical Record Linkage; Medical Records; Mortality; Patient Admission; Pregnancy

In 1148 cases the serum digoxin concentration (SDC) was correlated with the extracardiac signs of digitalis intoxication. There is a considerably overlap of SDC levels of patients with and without extracardiac signs of toxicity even though the mean SDC's of these two groups differ significantly. An increasing percentage of clinical intoxicated patients with increasing SDC levels was found at digoxin concentrations of 2.0 ng/ml and higher. At lower SDC levels patients with and without extracardiac signs of digitalis intoxication did not differ significantly in their mean SDC but in mean age and in mean creatinine concentration indicating that at least part of the symptoms in these patients might be due to a more severe illness. We could show that many of the extracardiac signs of digitalis intoxication are also seen in patients with impaired kidney function at low SDC levels and may lead to a wrong diagnosis. The most common complaint in patients with SDC's of 2.0 ng/ml and more is nausea (39.4%), followed by tiredness (30.4%), dizzyness (23.7%), vomiting (23.1%), headache (16.0%), visual disturbances (13,5%), colour (yellow) seeing (6;7%), diarrhea (4.2%) and severe neuro-psychiatric disturbances (3.8%). In patients with digitalis-induced arrhythmias the sequence of symptoms is the same only with a somewhat higher percentage rate. Only about one half of the patients with digitalis-induced arrhythmias and SDC values up to 2.5 ng/ml showed also extracardiac signs of intoxication. Therefore these signs are not to be taken as early symptoms of digitalis intoxication. Divided into subgroups (patients with/without digitalis-induced arrhythmias, patients with SDC values of more/less than 2.0 ng/ml) the patients with and without extracardiac signs of digitalis toxicity are compared with each other in regard to: mean body height and weight, concentration of digoxin, potassium and creatinine, digoxin dosage and mean age. The greatest differences were found between patients with combined cardiac and extracardiac signs of intoxication and patients with neither cardiac nor extracardiac signs of intoxication: These intoxicated patients are of significantly higher mean age and lower body weight, their mean concentration of digoxin and creatinine and the digoxin dosage administered are significantly greater, but there is no significant difference in potassium concentration. An important group of patients, namely the elderly with impaired kidney function, are especially p

Topics: Age Factors; Creatinine; Diarrhea; Digoxin; Electrocardiography; Fatigue; Headache; Humans; Nausea; Vertigo; Vision Disorders; Vomiting