Summary
The intestinal absorption of digoxin is essentially a passive non-saturable diffusion process, although a saturable carrier-mediated component also plays an important role. The bioavailability varies between 40 and 100%: the presence of food may reduce the peak serum concentration, but does not reduce the amount of digoxin absorbed. Recent development of a capsule containing a hydroalcoholic vehicle may reduce interindividual variations in absorption.
Pharmacokinetic analysis of the distribution of digoxin suggests 3 compartments, the slow distribution phase accounting for the lag time between the inotropic effects and the plasma concentration profile. Digoxin is extensively bound to tissues such as myocardium, renal, skeletal muscle as well as red blood cells, but not to adipose tissue. Plasma protein binding varies between 20 and 30%: displacement of digoxin from protein binding sites does not cause significant clinical effects. As expected, haemodialysis or exchange transfusions do not significantly alter the body load of digoxin. The apparent volume of distribution of digoxin varies between 5 and 7.3 L/kg; this may be reduced by, for example, electrolyte abnormalities which reduce digoxin binding to the myocardium.
The elimination half-life of digoxin is 36 hours, with 60 to 80% being excreted unchanged, by passive glomerular filtration and active tubular secretion. The remainder is excreted non-renally. Clearance is therefore dependent on renal function and declines in renal disease and in elderly patients.
Digoxin interacts with other drugs at any stage of absorption (e.g. cholestyramine), distribution (e.g. quinidine), metabolism (e.g. phenytoin) or elimination (e.g. diltiazem). Patients should. therefore. be carefully monitored when changing a therapeutic regimen which includes any drugs known to interact with digoxin. Clinical monitoring is more important than therapeutic drug monitoring which should be reserved for suspected toxicity. doubts about efficacy. or in cases of poor compliance.
With the advent of newer treatment modalities. digoxin is no longer the treatment of first choice in supraventricular arrhythmias and congestive heart failure. However, with careful monitoring. digoxin remains an important therapeutic option.
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References
Ackerman GL, Doherty JE, Flanigan WJ. Peritoneal dialysis and hemodialysis of tritiated digoxin. Annals of Internal Medicine 67: 718–723, 1967
Arnold SB, Byrd RC, Meister W, Melmon K, Cheitlin MD, et al. Long-term digitalis therapy improves left ventricular function in heart failure. New England Journal of Medicine 303: 1443–1448, 1980
Aronson JK. Clinical pharmacokinetics of digoxin 1980. Clinical Pharmacokinetics 5: 137–149, 1980
Barbarash RA. Serum digoxin measurements during pregnancy. European Journal of Clinical Pharmacology 27: 125, 1984
Beermann B, Hellstrom K, Rosen A. The absorption of orally administered [123H] digoxin in man. Clinical Science 43: 507–518, 1972
Beermann B, Hellstrom K, Rosen A. The gastrointestinal absorption of digoxin in seven patients with gastric or small intestinal reconstruction. Acta Medica Scandinavica 193: 293–297, 1973
Belz GG, Wistuba S, Matthews JH. Digoxin and bepridil: pharmacokinetic and pharmacodynamic interactions. Clinical Pharmacology and Therapeutics 39: 65–71, 1986
Bigger JT, Fleiss JL, Rolnitsky LM, Merab JP, Ferrick KJ. Effect of digitalis treatment on survival after acute myocardial infarction. American Journal of Cardiology 55: 623–630, 1985
Bissett JK, Doherty JE, Dalrymple GV, Flanigan WJ. Digoxin turnover studies in diabetes insipidus. Clinical Research 20: 364, 1972
Boman K, Allgulander S, Skoglund M. Is maintenance digoxin necessary in geriatric patients? Acta Medica Scandinavica 210: 493–495, 1981
Bonelli J, Haydl H, Hruby K, Kaik G. The pharmacokinetics of digoxin in patients with manifest hyperthyroidism and after normalization of thyroid function. International Journal of Clinical Pharmacology, Therapy and Toxicology 16: 302–306, 1978
Brooker G, Jelliffe RW. Serum cardiac glycoside assay based upon displacement of 3H-ouabain from Na-K-ATPase. Circulation 45: 20–36, 1972
Brown DD, Juhl RP. Decreased bioavailability of digoxin due to antacids and kaolin-pectin. New England Journal of Medicine 295: 1034–1037, 1976
Burnett GH, Conklin RL. The enzymatic assay of plasma digitoxin levels. Journal of Laboratory and Clinical Medicine 71: 1040–1044, 1968
Byington R, Goldstein S. The BHAT Research Group: Association of digitalis therapy with mortality in survivors of acute myocardial infarction: observations in the beta-blocker heart attack trial. Journal of the American College of Cardiology 6: 976–982, 1985
Caldwell JH, Greenberger NJ. Interruption of the enterohepatic circulation of digitoxin by cholestyramine. I. Protection against lethal digitoxin intoxications. Journal of Clinical Investigation 50: 2626–2637, 1971
Caldwell JH, Martin JF, Dutta S, Greenberger NJ. Intestinal absorption of digoxin 3H in the rat. American Journal of Physiology 217: 1747–1751, 1969
Captopril-Digoxin Multicenter Research Group. Comparative effects of therapy with captopril and digoxin in patients with mild to moderate heart failure. Journal of the American Medical Association 259: 539–544, 1988
Carlson KJ, Lee DC-S, Goroll AH, Leahy M, Johnson RA. An analysis of physicians’ reasons for prescribing long-term digitalis therapy in outpatients. Journal of Chronic Diseases 38: 733–739, 1985
Chaffman M, Brogden RN. Diltiazem. A review of its pharmacological properties and therapeutic efficacy. Drugs 29: 387–454, 1985
Chamberlain DA, White RJ, Howard MR, Smith TW. Plasma digoxin concentrations in patients with atrial fibrillation. British Medical Journal 3: 429–432, 1970
Chellingswort M. Digitalis in the elderly. Journal of Clinical and Hospital Pharmacy 11: 15–19, 1986
Clark DR, Inloes RL, Kalman SM, Sussman HH. Abbott TDx, Dade Stratus, and DuPont aca automated digoxin immunoassays compared with a reference radioimmunoassay method. Clinical Chemistry 32: 381–385, 1986
Cogan JJ, Humphreys MH, Carlson CT, Benowitz NL, Rapaport E. Acute vasodilator therapy increases renal clearance of digoxin in patients with congestive heart failure. Circulation 64: 973–976, 1981
Cokkinos DV, Tsartsalis GD, Heimonas ET, Gardikas CD. Comparison of the inotropic action of digitalis and isoproterenol in younger and older individuals. American Heart Journal 100: 802–806, 1980
Coltart DJ, Watson D, Howard MR. Effect of exchange transfusion on plasma digoxin levels. Archives of Disease in Childhood 47: 814–815, 1972
Croxson MS, Ibbertson HK. Serum digoxin in patients with thyroid disease. British Medical Journal 3: 566–568, 1975
Dimant J, Merrit W. Serum digoxin levels in elderly nursing home patients: appraisal of routine periodic measurements. Journal of the American Geriatrics Society 26: 378–379, 1978
Dobkin JF, Saha JR, Butler Jr VP, Neu HC, Lindenbaum J. Digoxin inactivating bacteria: identification in human gut flora. Science 220: 325–327, 1983
Doherty JE. The clinical pharmacology of digitalis glycosides: a review. American Journal of Medical Sciences 255: 382–414, 1968
Doherty JE. The influence of renal function on digoxin metabolism. In Storstein et al. (Eds) Digitalis, pp. 158–168, Gyldendal Norsk Forlag, Oslo, 1983
Doherty JE, Perkins WA. Digoxin metabolism in hypo- and hyperthyroidism: studies with tritiated digoxin in thyroid disease. Annals of Internal Medicine 64: 489–507, 1966
Doherty JE, Perkins WH, Gammill J, Sherwood J, Dodd C, et al. The influence of thyroid function on digoxin metabolism. In Storstein et al. (Eds) Digitalis, pp. 348-361, Gyldendal Norsk Forlag, Oslo, 1983
Donovan MA, Castleden CM, Pohl JEF, Kraft CA. The efTect of age on digitoxin pharmacokinetics. British Journal of Clinical Pharmacology 1: 401–402, 1981
Ewy GA, Groves BM, Ball MF, Nimmo L, Jackson B, et al. Digoxin metabolism in obesity. Circulation 44: 810–814, 1971
Fleg JL, Gottlieb SH, Lakatta EG. Is digoxin really important in the treatment of compensated heart failure? A placebo-controlled crossover study in patients with sinus rhythm. American Journal of Medicine 3: 244–250, 1982
Friedel HA, Sorkin EM. Nisoldipine. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in the treatment of angina pectoris, hypertension and related cardiovascular disorders. Drugs 36: (in press) 1988
Gault MH. Longerich LL, Loo JCK, Ko PTH, Fine A, et al. Digoxin biotransformation. Clinical Pharmacology and Therapeutics 35: 78–82, 1983
Gault H, Vasdev S, Vlassess P, Longerich L, Dawe M. Interpretation of serum digoxin values in renal failure. Clinical Pharmacology and Therapeutics 39: 530–536, 1986
Gheorghiade M, Beller GA. Effects of discontinuing maintenance digoxin therapy in patients with ischemic heart diseases and congestive heart failure in sinus rhythm. American Journal of Cardiology 51: 1242–1250, 1983
Giardina ACV, Ehlers KH, Morrison JB, Engle MIA. Serum digitoxin concentrations in infants and children. Circulation 51: 713–717, 1975
Gibson TP, Nelson HA. The question of accumulation of digoxin metabolites in renal failure. Clinical Pharmacology and Therapeutics 27: 219–223, 1980
Gilfrich HJ. Untersuchungen zur pharmakokinetik von digoxin bei hyperthyreosen patienten. Verhandlungen Der Deutschen Gesflischaft Fur Innere Medizin 25: 1726–1728, 1976
Gjerdrum K. Determination of digitalis in blood. Acta Medica Scandinavica 187: 371–379, 1970
Goa KL, Sorkin EM. Nitrendipine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in the treatment of hypertension. Drugs 33: 123–155, 1987
Goldstein RL, Stanton BA, Lipson MJ. Clinical utility of serum digoxin level tests in hospitalized elderly patients. Archives of Physical Medicine and Rehabilitation 67: 34–37, 1986
Graves PE, Fenster PE, MacFarland RT, Marcus FI, Perrier D. Kinetics of digitoxin and the bis- and monodigitoxosides of digitoxigenin in normal subjects. Clinical Pharmacology and Therapeutics 36: 601–606, 1984a
Graves PE, Fenster PE, MacFarland RT, Marcus FI, Perrier D. Kinetics of digitoxin and the bis- and monodigitoxosides of digitoxigenin in renal insufficiency. Clinical Pharmacology and Therapeutics 36: 607–612, 1984b
Greenberger NJ, Caldwell JH. Studies on the intestinal absorption of 3H-digitalis glycosides in experimental animals and man. In Marks & Weissler (Eds) Basic and clinical pharmacology of digitalis, pp. 15–47, Charles C. Thomas, Springfield, 1972
Griffiths BE, Penny WJ, Lewis MJ, Henderson AH. Maintenance of the inotropic effect of digoxin on long-term treatment. British Medical Journal 284: 1819–1822, 1982
Haass A, Lullman H, Peters T. Absorption rates of some cardiac glycosides and portal blood flow. European Journal of Pharmacology 19: 366–370, 1972
Harron DWG, Brogden RN. Propafenone: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in the treatment of arrhythmias. Drugs 34: 617–647, 1987
Hastreiter AR, Van der Horst RM. Postmortem digoxin tissue concentration and organ content in infancy and childhood. American Journal of Cardiology 52: 330–335, 1983
Heizer WD, Smith TW, Goldfinger SE. Absorption of digoxin in patients with malabsorption syndromes. New England Journal of Medicine 285: 257–259, 1971
Hinderling PH, Magnusson JO, Molin L. Comparative in vivo evaluation of a radioimmunoassay and a chromatographic assay for the measurement of digoxin in biological fluids. Journal of Pharmaceutical Sciences 75: 517–521, 1986
Holmes B, Heel RC. Flecainide: a preliminary review of its pharmacodynamic properties and therapeutic efficacy. Drugs 29: 1–33, 1985
Huffman DH, Azarnoff DL. Absorption of orally given digoxin preparations. Journal of the American Medical Association 222: 957–960, 1972
Iisalo E. Clinical pharmacokinetics of digoxin. Clinical Pharmacokinetics 2: 1–16, 1977
Impivaara O, Iisalo E, Aromaa A, Maatela J, Reunanen A. Over-prescription and underprescription of digitalis. Acta Medica Scandinavica 219: 455–460, 1986
Jogestrand T. Digoxin concentration in right atrial myocardium, skeletal muscle and serum in man: influence of atrial rhythm. European Journal of Clinical Pharmacology 17: 243–250, 1980
Joy ME, Higbee MD. Extracardiac manifestation of digitalis toxicity in the elderly. Hospital Formulary 20: 1015–1022, 1985
Jusko WJ, Weintrau M. Myocardial distribution of digoxin and renal function. Clinical Pharmacology and Therapeutics 16: 449–454, 1974
Katano Y, Kennedy RH, Stemmer PM, Temma K, Akera T. Aging and digitalis sensitivity of cardiac muscle in rats. European Journal of Pharmacology 113: 167–178, 1985
Kennedy HL, Sprague MK, Redd RM, Wiens RD, Blum RL, et al. Serum digoxin concentrations during ethmozine antiarrhythmic therapy. American Heart Journal 111: 667–672, 1986
Kerenyi TD, Gleicher N, Meller J, Brown E, Steinfeld L, et al. Transplacental cardioversion of intrauterine supraventricular tachycardia with digitalis. Lancet 2: 393–395, 1980
King CR, Mattioli L, Goertz KK, Snodgrass W. Successful treatment of fetal supraventricular tachycardia with maternal digoxin therapy. Chest 85: 573–575, 1984
Kirch W, Hutt HJ, Dylewicz P, Graf KJ, Ohnhaus EE. Dose-dependence of nifedipine-digoxin interaction. Clinical Pharmacology and Therapeutics 39: 35–39, 1986
Kirch W, Hutt HJ, Heidemann H, Ramsch K, Janisch HD, et al. Drug interactions with nitrendipine. Journal of Cardiovascular Pharmacology 6: 5982–5985, 1984
Klein HO, Lang R, Weiss E, Segni ED, Libhaber C, et al. The influence of verapamil on serum digoxin concentration. Circulation 65: 998–1003, 1982
Koup JR, Greenblatt DJ, Jusko WJ, Smith TW, Koch-Weser J. Pharmacokinetics of digoxin in normal subjects after intravenous bolus and infusion doses. Journal of Pharmacokinetics and Biopharmaceutics 3: 181–192, 1975a
Koup KR, Jusko WJ, Elwood CM, Kohli RK. Digoxin pharmacokinetics: role of renal failure in dosage regimen design. Clinical Pharmacology and Therapeutics 18: 9–21, 1975b
Krakauer R, Steiners E. Digoxin concentration in choroid plexus, brain and myocardium in old age. Clinical Pharmacology and Therapeutics 24: 454–458, 1978
Kroening BH, Weintraub M. Age-associated changes in tissue distribution and uptake of 3H-digoxin in mice and guinea pigs. Pharmacology 20: 21–26, 1980
Kuhlmann J. Effects of verapamil, diltiazem, and nifedipine on plasma levels and renal excretion of digitoxin. Clinical Pharmacology and Therapeutics 38: 667–673, 1985
Kuhlmann J, Dohrmann M, Marcin S. Effects of quinidine on pharmacokinetics and pharmacodynamics of digitoxin achieving steady-state conditions. Clinical Pharmacology and Therapeutics 39: 288–294, 1986
Lackner ThE, Valdes R. Spurious digoxin concentration. European Journal of Clinical Pharmacology 26: 531, 1984
Larsen A, Storstein L. Digitoxin kinetics and renal excretion in children. Clinical Pharmacology and Therapeutics 33: 717–726, 1983
Lauterbach F. Intestinal absorption and secretion of cardiac glycosides. In Greeff K (Ed.) Handbook of experimental pharmacology, vol. 56/II, cardiac glycosides pp. 105–139. Springer-Verlag, Berlin, 1981
Leakey EB, Bigger JT, Butler Jr VP, Reiffel JA, O’Connoll GC, et al. Quinidine-digoxin interaction time course and pharmacokinetics. American Journal of Cardiology 48: 1141–1146, 1981
Lee DC-S, Johnson RA, Bingham JB, Leahy M, Dinsmore RE, et al. Heart failure in outpatients: a randomised trial of digoxin versus placebo. New England Journal of Medicine 306: 699–705, 1982
Lehmann DR. Improvements to the SYVA fluorescence energy transfer immunoassay for digoxin. Clinical Biochemistry 18: 300–303, 1985
Lindenbaum J, Mellow MH, Blackstone MO, Butler Jr VP. Variation in biologic availability of digoxin from four preparations. New England Journal of Medicine 285: 1344–1347, 1971
Lindenbaum J, Rund DG, Butler Jr VP, Tse-Eng D, Saha RJ. Inactivation of digoxin by the gut flora: reversal by antibiotic therapy. New England Journal of Medicine 305: 789–794, 1981b
Lindenbaum J, Tse-Eng D, Butler Jr VP, Rund DG. Urinary excretion of reduced metabolites of digoxin. American Journal of Medicine 71: 67–74, 1981a
Lingman G, Ohrlanders MH, Ohlin P. Intrauterine digoxin treatment of fetal paroxysmal tachycardia. British Journal of Obstetrics and Gynecology 87: 340–344, 1980
Lukas DS. Some aspects of the distribution and disposition of digitoxin in man. Annals of the New York Academy of Sciences 179: 338–361, 1971
Lukas DS. The pharmacokinetics and metabolism of digitoxin in man. In Storstein et al. (Eds) Digitalis, pp. 84–102, Gyldendal Norsk Forlag, Oslo, 1973
Lukas DS, De Martino AG. Binding of digitoxin and some related cardenolides to human plasma proteins. Journal of Clinical Investigation 48: 1041–1053, 1969
Lukas DS, Peterson RE. Double isotope dilution derivative assay of digitoxin in plasma, urine and stool of patients maintained on the drug. Journal of Clinical Investigation 45: 782–795, 1966
Luxford AME, Kellaway GSM. Pharmacokinetics of digoxin in pregnancy. European Journal of Clinical Pharmacology 25: 117–121, 1985
MacFarland RT, Marcus FI, Fenster PE, Graves PE, Perrier D. Pharmacokinetics and bioavailability of digitoxin by a specific assay. European Journal of Clinical Pharmacology 27: 85–89, 1984
Madsen EB, Gilpin E, Henning H, Ahorre S, Le Winter M, et al. Prognostic importance of digitalis after myocardial infarction. Journal of the American College of Cardiology 3: 681–689, 1984
Marcus FI, Horton H, Jacobs S, Pippin S, Stafford M, et al. The effect of jejunoileal bypass in patients with morbid obesity on the pharmacokinetics of digoxin (dig) in man. American Journal of Cardiology 37: 154(A), 1976
Misra M. Intestinal permeation kinetics of digitoxin. Naunyn-Schmiedeberg’s Archives of Pharmacology 322(Suppl. R15): 1983
Morselli PL, Assael BM, Gomeni R, Mandelli M, Marini A, et al. Digoxin pharmacokinetics during human development. In Morselli et al. (Eds) Basic and therapeutic aspects of perinatal pharmacology, pp. 377–409, Raven Press, New York. 1975
Molin L. Factors of importance for valid digitalis assays, particularly for the determination of digoxin in plasma and urine. Acta Pharmacologica et Toxicologica 59 (Suppl. 4): 1–62, 1986
Mooradian AD, Wynn EM. Pharmacokinetic prediction of serum digoxin concentration in the elderlv. Archives of Internal Medicine 147: 650–653, 1987
Moss AJ, Davis HT, Conard DL, DeCamilla JJ, Odoroff CL. Digitalis associated cardiac mortality after myocardial infarction. Circulation 64: 1150–1156, 1981
Moysey JO, Jaggarao NSV, Grundy EN, Chamberlain DA. Amiodarone increases plasma digoxin concentrations. British Medical Journal 282: 272, 1981
Muller JE, Turi ZG, Stone PH, Rude RE, Raabe DS. et al. Digoxin therapy and mortality after myocardial infarction: experience in the MI LIS Study. New England Journal of Medicine 314: 265–271, 1986
Nanji AA, Greenway DC. Widely differing plasma digoxin values in patients with congestive heart failure and severe liver dysfunction: a method dependent problem. Archives of Pathology and Laboratory Medicine 110: 75–76, 1986
North DS, Mattern AL, Hiser WW. The influence of diltiazem hydrochloride on trough serum digoxin concentrations. Drug Intelligence and Clinical Pharmacy 20: 500–503, 1986
Ochs HR, Greenblatt DJ, Verburg-Ochs B. Effect of alprazolam on digoxin kinetics and creatinine clearance. Clinical Pharmacology and Therapeutics 38: 595–598, 1985
Ohnhaus EE, Vozeh S, Nuesch E. Absorption of digoxin in severe right heart failure. European Journal of Clinical Pharmacology 15: 115–120, 1979
Okita GT. Distribution, disposition and excretion of digitalis glycosides. In Fisch & Surawicz (Eds) Digitalis, pp. 13–26, Grune and Stratton, New York, 1969
Paulson MF, Welling PG. Calculation of serum digoxin levels in patients with normal and impaired renal function. Journal of Clinical Pharmacology 16: 660–665, 1976
Pedersen KE. Digoxin interactions: the influence of quinidine and verapamil on the pharmacokinetics and receptor binding of digitalis glycosides. Acta Medica Scandinavica 697 (Suppl.): 11–40, 1985
Pedersen KR, Christiansen BD, Klitgaard NA, Nielsen-Kudsk F. Effect of quinidine on digoxin bioavailability. European Journal of Clinical Pharmacology 24: 41–47, 1983a
Pedersen KE, Thayssen P, Klitgaard NA, Christiansen BD, Nielsen-Kudsk F. The influence of verapamil on digoxin inotropism and pharmacokinetics. European Journal of Clinical Pharmacology 25: 199–206, 1983b
Peters U, Falk LC, Kalman SM. Digoxin metabolism in patients. Archives of Internal Medicine 138: 1074–1076, 1978
Platt D, Schoch P. The effect of age and cardiac glycosides on the activity of adenosine triphosphatase (ATPase) (E.C. 3.6.1.3.) of red cell ghost membranes. Mechanisms of Aging and Development 3: 245–252, 1974
Plebani M, Burlina A. Fluorescence energy transfer immunoassay of digoxin in serum. Clinical Chemistry 31: 1879–1881, 1985
Plum J, Daldrup T. Detection of digoxin, digitoxin, and their cardioactive metabolites and derivatives by high-performance liquid chromatography and high-performance liquid chromatography-radioimmunoassay. Journal of Chromatography 377: 221–231, 1986
Portnoi VA. Digitalis delirium in elderly patients. Journal of Clinical Pharmacology 19: 747–750, 1979
Pudek MR, Seccombe DW, Jacobson BE, Humphries K. Effect of assay conditions on cross reactivity of digoxin-like immunoreactive substance(s) with radioimmunoassay kits. Clinical Chemistry 31: 1806–1810, 1985
Pudek MR, Seccombe DW, Whitefield MF, Ling E. Digoxin-like immunoreactivity in premature and full-term infants not receiving digoxin therapy. New England Journal of Medicine 308: 904–905, 1983
Quattrocchi FP, Robinson JD, Curry Jr RW, Grieco ML, Schulman SG. The effect of ibuprofen on serum digoxin concentrations. Drug Intelligence and Clinical Pharmacy 17: 286–288, 1983
Reuning RH, Sams RA, Notari RE. Role of pharmacokinetics in drug dosage adjustment. I. Pharmacologic effect, kinetics and apparent volume of distribution of digoxin. Journal of Clinical Pharmacology 13: 127–141, 1973
Rogers MC, Willerson JT, Goldblatt A, Smith TW. Serum digoxin concentrations in the human fetus, neonate and infant. New England Journal of Medicine 287: 1010–1013, 1972
Rosen MR, Wit AL, Hoffman BF. Electrophysiology and pharmacology of cardiac arrhythmias. IV. Cardiac arrhythmic and toxic effects of digitalis. American Heart Journal 89: 391–399, 1975
Rund DG, Lindenbaum J, Dobkin JF, Butler Jr VP, Saha JR. Decreased digoxin cardioinactive-reduced metabolites after administration as an encapsulated liquid concentrate. Clinical Pharmacology and Therapeutics 34: 738–743, 1983
Ryan TJ, Bailey KR, McCabe CH, Luk S, Fisher LD, et al. The effect of digitalis on survival in high-risk patients with coronary artery disease (CASS). Circulation 67: 735–742, 1983
Salerno DM, Granrud G, Sharkey P, Asinger R, Hodges M. A controlled trial of propafenone for treatment of frequent and repetitive ventricular premature complexes. American Journal of Cardiology 53: 77–83, 1984
Schafer SG, Schuhmann G, Doering W, Fichtl B. Influence of quinidine on the intestinal secretion of digoxin and digitoxin in guinea pigs. Chemico-biological Interactions 55: 203–213, 1985
Schafer-Korting M, Belz GG, Brauer J, Aiken RG, Mutschler E. Digoxin concentrations in serum and cantharides blister fluid: correlations with cardiac response. Clinical Pharmacology and Therapeutics 42: 613–620, 1987
Schenck-Gustafsson K, Jogestrand T, Nordlander R, Dahlqvist R. Effect of quinidine on digoxin concentration in skeletal muscle and serum in patients with atrial fibrillation: evidence for reduced binding of digoxin in muscle. New England of Medicine 305: 209–211, 1981
Selden R, Margolies MN, Smith TW. Renal and gastrointestinal excretion of ouabain in dog and man. Journal of Pharmacology and Experimental Therapeutics 188: 615–623, 1974
Selden R, Smith TW. Ouabain pharmacokinetics in dog and man: determination by radioimmunoassay. Circulation 45: 1176–1182, 1972
Shaw TRD, Howard MR, Hamer J. Variation in the biological availability of digoxin. Lancet 2: 303–307, 1972
Shelman Jr JL, Locke RV. Transplacental neonatal digitalis intoxication. American Journal of Cardiology 6: 834–837, 1960
Smith TW, Haber E. Digitalis III. New England Journal of Medicine 289: 1063–1072, 1973a
Smith TW, Haber E. Clinical value of the radio-immunoassay of the digitalis glycosides. Pharmacology Review 25: 219–228, 1973b
Solomon HM, Abrams WS. Interactions between digitoxin and other drugs in man. American Heart Journal 83: 277–280, 1972
Sorkin EM, Clissold SP. Nicardipine: A review of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy, in the treatment of angina pectoris, hypertension and related cardiovascular disorders. Drugs 33: 296–345, 1987
Sorkin EM, Clissold SP, Brogden RN. Nifedipine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy, in ischaemic heart disease, hypertension and related cardiovascular disorders. Drugs 30: 182–274, 1985
Spinnato JA, Shaver DC, Flinn GS, Sibai B, Watson DL, et al. Fetal supraventricular tachycardia: in utero therapy with digoxin and quinidine. Obstetrics and Gynecology 64: 730–735, 1984
Steiness E. Renal tubular secretion of digoxin. Circulation 50: 103–107, 1974
Storstein L. The influence of renal function on the pharmacokinetics of digitoxin. In Storstein et al. (Eds) Digitalis, pp. 158–168, Glyndendal Norsk Forlag, Oslo, 1983
Stults BM. Digoxin use in the elderly. Journal of the American Geriatrics Society 30: 158–164, 1982
Sumner DJ, Russel AJ. Digoxin pharmacokinetics: multicompartmental analysis and its implications. British Journal of Clinical Pharmacology 3: 221–229, 1976
Thong B, Soldin SJ, Lingwood CA. Lack of specificity of current antidigoxin antibodies and preparation of a new, specific polyclonal antibody that recognizes the carbohydrate moiety of digoxin. Clinical Chemistry 31: 1625–1631, 1985
Uekama K, Fujinaga T, Hirayama F, Otagiri M, Yamasaki M, et al. Improvement of the oral bioavailability of digitalis glycosides by cyclodextrin complexation. Journal of Pharmaceutical Sciences 72: 1338–1341, 1983
Valdes R, Graves SW, Brown BA, Landt M. Endogenous substance in newborn infants causing false positive digoxin measurements. Journal of Pediatrics 102: 947–950, 1983
van Bezooijen CFA, Boonstra-Nieveld IHJ, Sakkee AN, Knook DC. A decrease in the capacity of hepatocytes isolated from aged male BN/Birij rats to metabolise digitoxin. Clinical Pharmacology 33: 3709–3711, 1984
Wagner JG, Christensen M, Sakmar E, Blair D, Yates JD, et al. Equivalence lack in digoxin plasma levels. Journal of the American Medical Association 224: 199–204, 1973
Watson E, Kalman SM. Assay of digoxin in plasma by gas chromatography. Journal of Chromatography 56: 209–218, 1971
Weber JN, Takemoto C. Digoxin interactions with the new antiarrhythmic agents. California Society of Hospital Pharmacists Voice 13: 65–66, 1986
Weeks CE, Conard GJ, Kvam DC, Fox JM, Chang SF, et al. The effect of flecainide acetate, a new antiarrhythmic, on plasma digoxin levels. Journal of Clinical Pharmacology 26: 27–31, 1986
White RJ, Chamberlain DA, Howard M, Smith TW. Plasma concentrations of digoxin after oral administration in the fasting and postprandial state. British Medical Journal 1: 380–381, 1971
Williamson J, Chopin JM. Adverse reactions to prescribed drugs in the elderly: a multicentre investigation. Age and Ageing 9: 73–80, 1980
Withering W. An account of the foxglove, and some of its medical uses, with practical remarks on dropsy, and other diseases. In Willins & Keyes (Eds) Classics of cardiology, pp. 231–252, Henry Schuman, New York, 1941
Yusuf S, Wittes J, Bailey K, Furberg C. Digitalis: a new controversy regarding an old drug: the pitfalls of inappropriate methods. Circulation 73: 14–18, 1986
Zilly W, Richter E, Rietblock N. Pharmacokinetics and metabolism of digoxin and β-methyl-digoxin-12α-3H in patients with acute hepatitis. Clinical Pharmacology and Therapeutics 17: 302–309, 1975
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Mooradian, A.D. Digitalis. Clin-Pharmacokinet 15, 165–179 (1988). https://doi.org/10.2165/00003088-198815030-00002
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DOI: https://doi.org/10.2165/00003088-198815030-00002