medigoxin and Drug-Overdose

A massive lethal overdose with beta-metildigoxin in a 36-week-old infant is presented. Determination of beta-metildigoxin and its metabolites digoxin, digoxigenin and digoxigenin-monodigitoxosid is achieved by a liquid chromatographic mass spectrometric (LC-MS/MS) method. Measured concentrations for beta-metildigoxin and digoxin in peripheral blood were 40.2 ng/ml and 25.6 ng/ml, respectively. Tissue distribution showed highest concentrations in kidney tissue and gastric content. The metabolite digoxigenin-monodigitoxosid could be detected in heart blood, duodenal content, gastric content and fat tissue while the metabolite digoxigenin could only be detected in gastric content since the drug was given by a stomach tube.

Topics: Cardiotonic Agents; Chromatography, Liquid; Digoxigenin; Digoxin; Drug Overdose; Forensic Toxicology; Humans; Hypertension, Pulmonary; Infant; Male; Medication Errors; Medigoxin; Tandem Mass Spectrometry; Tissue Distribution

Three cases of patients with symptoms of digitalis overdosage were presented. The principal manifestations included complex supraventricular dysrhythmias and atrio-ventricular conduction disturbances. In the discussion a special attention was paid to digitalis dosage. Multiple factors influencing plasma concentration of digitalis including pharmacokinetics, bioavailability and drug interactions with glycosides were described. Short review of toxic manifestations of digitalis was made and the treatment of digitalis intoxication was outlined.

Topics: Aged; Aged, 80 and over; Arrhythmias, Cardiac; Atrioventricular Node; Captopril; Digitalis; Digitalis Glycosides; Drug Interactions; Drug Overdose; Drug Therapy, Combination; Female; Heart Conduction System; Humans; Male; Medigoxin; Middle Aged; Pentoxifylline; Plants, Medicinal; Plants, Toxic; Tachycardia, Supraventricular

We reported a 79 year old man with preoperative bradycardia due to relative overdose of digitalis prior to undergoing subtotal gastrectomy. The patient had received metildigoxin 0.2 mg.day-1 for atrial fibrillation preoperatively and severe bradycardia of 35-41 bpm was found on the preoperative ECG examination. Serum digoxin level was detected to be 1.91 ng.ml-1 on the day before surgery. We thought this serum level must be toxic for him, even though it was within normal limits for the majority. As we thought that his bradycardia had been caused by relative overdose of digitalis, he was withheld to receive metildigoxin on the day before surgery and thereafter. Heart rate on arrival at the operating theater was around 40-45 bpm, and therefore the patient was placed on a temporary pacemaker catheter before the anesthetic induction to prevent aggravating bradycardia during anesthesia and surgery. Heart rate during procedure was 50-70 bpm and hemodynamics was stable. Intravenous digoxin was restarted on the 2nd postoperative day because of decrease in serum digoxin level to 0.84 ng.ml-1 and it was converted to metildigoxin 0.1 mg.day-1 when he was permitted to take pills per os. Our experience demonstrates that perioperative therapeutic drug monitoring is clinically important for anesthesiologists to make proper pharmacological management of surgical patients who have received digitalis.

Topics: Aged; Anesthesia, General; Anti-Arrhythmia Agents; Atrial Fibrillation; Bradycardia; Drug Monitoring; Drug Overdose; Gastrectomy; Hemodynamics; Humans; Intraoperative Complications; Male; Medigoxin; Pacemaker, Artificial; Stomach Neoplasms

The efficacy of beta methyldigoxin was examined in a group of 40 elderly patients who had been hospitalised due to congested heart decompensation. A good clinical response was obtained in 95.5% of cases with the presence of slight toxic phenomena in 2 cases only (4.5%). The paper underlines the excellent pharmacokinetic pattern of the substance used in the steady state. Steady state digitalemic values were within the acceptable range in 83.76% of cases, whereas underdosage and overdosage phenomena were observed in 6.87% and 9.37% of patients respectively.

Topics: Aged; Aged, 80 and over; Drug Evaluation; Drug Overdose; Female; Heart Failure; Hospitalization; Humans; Male; Medigoxin; Time Factors