digoxin and Drug-Hypersensitivity

There is limited evidence to suggest that the incidence of adverse drug reactions increases with patient age. Factors which may predispose the elderly to adverse drug reactions include multiple drug therapy and changes in pharmacokinetics and pharmacodynamics associated with ageing. Digoxin, diuretics and psychotropic drugs may be particularly hazardous in this age group.

Topics: Aged; Antidepressive Agents; Benzodiazepines; Cohort Studies; Digoxin; Diuretics; Drug Hypersensitivity; Drug Interactions; Drug-Related Side Effects and Adverse Reactions; Humans; Pharmacokinetics

An observational surveillance study was conducted to monitor the safety and effectiveness of treatment with Digoxin Immune Fab (Ovine) (Digibind) in patients with digitalis intoxication. Before April 1986, a relatively limited number of patients received treatment with digoxin-specific Fab fragments through a multicenter clinical trial. Beginning with commercial availability in July 1986, this study sought additional, voluntarily reported clinical data pertaining to treatment through a 3 week follow-up. The study included 717 adults who received Digoxin Immune Fab (Ovine). Most patients were greater than or equal to 70 years old and developed toxicity during maintenance dosing with digoxin. Fifty percent of patients were reported to have a complete response to treatment, 24% a partial response and 12% no response. The response for 14% of patients was not reported or reported as uncertain. Six patients (0.8%, 95% confidence interval 0.3% to 1.8%) had an allergic reaction to digoxin-specific antibody fragments. Three of the six had a history of allergy to antibiotic drugs. Twenty patients (2.8%, 95% confidence interval 1.7% to 4.3%) developed recrudescent toxicity. Risk of recrudescent toxicity increased sixfold when less than 50% of the estimated dose of antibody was administered. A total of 215 patients experienced posttreatment adverse events. The events for 163 patients (76%) were judged to result from manifestations of underlying disease and thus considered unrelated to Fab treatment. Digoxin-specific antibody fragments were generally well tolerated and clinically effective in patients judged by treating physicians to have potentially life-threatening digitalis intoxication.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Creatinine; Digitalis Glycosides; Digoxin; Drug Hypersensitivity; Female; Follow-Up Studies; Heart Diseases; Humans; Immunoglobulin Fab Fragments; Incidence; Male; Middle Aged; Retrospective Studies; Risk Factors; Skin Tests; Suicide, Attempted

Several side effects of drugs observed in an office of a general practitioner are described. The cause of these side effects, their prevention and their treatment are discussed.

Topics: Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Anaphylaxis; Anti-Inflammatory Agents, Non-Steroidal; Cosyntropin; Diclofenac; Digoxin; Drug Eruptions; Drug Hypersensitivity; Drug Interactions; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Nitrofurantoin; Penicillin G Procaine; Risk Factors; Verapamil

The clinical pharmacology of ibuprofen (Motrin, Upjohn) in relation to the pathophysiologic aspects of various diseases is explained. An understanding of prostaglandin's numerous effects can help the clinician to expand the use of ibuprofen (as in Barttern's syndrome) and to exercise caution as warranted, as when treating patients with renal disease. Knowledge of ibuprofen's clinical pharmacology may also enable practitioners to prescribe the drug rationally in situations not well represented in the literature, as in the elderly or in individuals with bleeding diatheses or severe liver disease. The use of ibuprofen in multiple-drug therapy with aspirin, warfarin, phenytoin, digoxin, or lithium is explored. Perusal of the literature enables the clinician to gain an awareness of patient subpopulations warranting careful use of medication, including the elderly or individuals with systemic lupus erythematosus, mixed connective tissue disease, or aspirin-induced asthma.

Topics: Arthritis, Rheumatoid; Aspirin; Bartter Syndrome; Cyclooxygenase Inhibitors; Digoxin; Drug Hypersensitivity; Drug Interactions; Ductus Arteriosus, Patent; Humans; Ibuprofen; Indomethacin; Kidney; Kinetics; Lithium; Liver; Lupus Erythematosus, Systemic; Mixed Connective Tissue Disease; Phenytoin; Platelet Aggregation; Prostaglandins E; Warfarin

Topics: Aged; Cardiac Glycosides; Digoxin; Dose-Response Relationship, Drug; Drug Hypersensitivity; Electrocardiography; Female; Heart Diseases; Humans; Hypoxia; Lung Diseases, Obstructive; Male; Middle Aged

A 60-year-old male patient had two episodes of thrombocytopaenia whilst being treated with digoxin, each of them reversible upon withdrawal of the drug. Bone marrow examination was consistent with peripheral platelet destruction as the main mechanism of the thrombocytopaenia. The inhibition of clot retraction test was positive, with a declining titer, after cessation of digoxin therapy, and this plus the finding of circulating immune complexes after incubation of the patient's serum with digoxin established digoxin as the offending agent. It is concluded that digoxin may be a rare cause of drug-induced immune-thrombocytopaenia.

Topics: Digoxin; Drug Hypersensitivity; Humans; Male; Middle Aged; Thrombocytopenia

Topics: Adrenergic beta-Antagonists; Aged; Antihypertensive Agents; Depression; Digoxin; Diuretics; Drug Hypersensitivity; Drug Prescriptions; Drug-Related Side Effects and Adverse Reactions; Humans; Hypoglycemic Agents; Inflammation; Intestinal Absorption; Pain; Pharmaceutical Preparations; Sleep Initiation and Maintenance Disorders

Radioimmunoassay is a simple method for estimating the concentration of cardiac glycosides in the blood. The technique is described. An condition of the accuracy of the estimation is that the drug levels in blood and tissue have reached equilibrium, since only then will the blood concentration accurately reflect the drug level in the tissues. The therapeutic plasma levels are 0.7 to 2.0 ng/ml for digoxin and 10-30 ng/ml for digitoxin. Indications for estimating the plasma glycoside levels are reviewed; they include suspected digitalis poisoning or intolerance, interaction of glycosides with other drugs and suspected negligence on the part of the patient to take the prescribed dose.

Topics: Albumins; Antibody Formation; Cardiac Glycosides; Digitoxin; Digoxin; Drug Hypersensitivity; Drug Interactions; Humans; Methods; Patient Compliance; Radioimmunoassay

Topics: Animals; Arrhythmias, Cardiac; Digoxin; Dogs; Drug Hypersensitivity; Humans; Hypokalemia; Myocardium; Potassium

Topics: Aged; Ajmaline; Aniline Compounds; Arrhythmias, Cardiac; Benzyl Compounds; Bone Marrow Examination; Cell Survival; Chromium Radioisotopes; Clot Retraction; Digoxin; Drug Combinations; Drug Hypersensitivity; Ethylenediamines; Histocytochemistry; Humans; Imidazoles; Male; Megakaryocytes; Phenobarbital; Sparteine; Thrombocytopenia

Topics: Adult; Age Factors; Aminoglycosides; Anti-Bacterial Agents; Carbenicillin; Diabetes Complications; Digoxin; Drug Hypersensitivity; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Heart Failure; Humans; Kanamycin; Male; Neurologic Manifestations; Penicillin Resistance; Penicillins; Pseudomonas aeruginosa; Pseudomonas Infections; Sex Factors; Substance-Related Disorders

Topics: Acute Disease; Aged; Arrhythmias, Cardiac; Blood Pressure Determination; Coronary Care Units; Digitalis Glycosides; Digoxin; Drug Hypersensitivity; Electrocardiography; Female; Heart Block; Humans; Male; Middle Aged; Myocardial Infarction; Ouabain; Strophanthins

Topics: Age Factors; Aged; Body Weight; Digoxin; Drug Hypersensitivity; Humans

Plasma digoxin concentrations were measured by radioimmunoassay in 116 patients with atrial fibrillation on long-term oral treatment with the drug, and in 23 patients with digoxin toxicity. The mean concentrations were 1.4 ng./ml. and 3.1 ng./ml., respectively. Though an overlap occurred between the therapeutic and toxic ranges, toxicity is unlikely to occur below a level of 2 ng./ml. Plasma concentration showed a poor correlation with resting heart rate during atrial fibrillation. In patients with good renal function, however, a significant correlation was found between oral dose and plasma concentration. No evidence was obtained for increased sensitivity to therapeutic concentrations of the drug in elderly subjects, but the doses required to achieve these concentrations tended to be less than in younger patients.

Topics: Administration, Oral; Adult; Age Factors; Aged; Atrial Fibrillation; Digoxin; Drug Hypersensitivity; Electrocardiography; Heart Rate; Humans; Kidney Function Tests; Middle Aged; Radioimmunoassay

Topics: Digoxin; Drug Hypersensitivity; Female; Humans; Middle Aged

Topics: Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Atropine; Bradycardia; Cardiac Complexes, Premature; Digoxin; Drug Hypersensitivity; Dyspnea; Heart Rate; Humans; Male; Middle Aged; Propranolol; Tachycardia; Uremia