MALABSORPTION OF DIGOXIN TABLETS, GEL CAPS, AND ELIXIR IN A PATIENT WITH AN END JEJUNOSTOMY

OBJECTIVE: To report a case of malabsorption of digoxin from tablets, gel caps, and elixir in a patient with an end jejunostomy. CASE SUMMAR Y: A 69-year-old man with 18 cm of functioning jejunum following a sur gical end jejunostomy was receiving oral digoxin. The patient presente d on referral for short bowel syndrome, secretory diarrhea, and malabs orption. He was receiving digoxin tablets 0.75 mg/d with a serum digox in concentration of 0.5 ng/mL. Attempts to achieve therapeutic digoxin serum concentrations of approximately 1.0 ng/mL by administration of digoxin in the form of liquid-filled gel caps and elixir were unsucces sful. DISCUSSION: Variable results have been presented in the literatu re regarding the ability to achieve therapeutic concentrations of digo xin following oral administration in patients with malabsorption syndr omes. Several studies have suggested that changing the form of adminis tered digoxin from tablet to elixir or liquid-filled gel caps may impr ove absorption in patients with small intestine malabsorption. Such ch anges in oral dosage form failed to achieve therapeutic digoxin serum concentrations in this case. CONCLUSIONS: The markedly diminished leng th and the lack of continuity of this patient's small intestine and co lon likely resulted in severe malabsorption of orally administered dig oxin. Some patients with end jejunostomies may require intravenous for ms of medication because of inadequate absorption of orally administer ed medications.