IS THE VOLUME OF DISTRIBUTION OF DIGOXIN REDUCED IN PATIENTS WITH RENAL DYSFUNCTION - DETERMINING DIGOXIN PHARMACOKINETICS BY FLUORESCENCE POLARIZATION IMMUNOASSAY
Jwm. Cheng et al., IS THE VOLUME OF DISTRIBUTION OF DIGOXIN REDUCED IN PATIENTS WITH RENAL DYSFUNCTION - DETERMINING DIGOXIN PHARMACOKINETICS BY FLUORESCENCE POLARIZATION IMMUNOASSAY, Pharmacotherapy, 17(3), 1997, pp. 584-590
Study Objective. To determine digoxin pharmacokinetics in subjects wit
h different degrees of renal function using fluorescence polarization
immunoassay (FPIA), which is associated with less interference from di
goxin-like immunoreactive substances (DLIS) than radioimmunoassay. Set
ting. University hospital clinical research center. Participants. Eigh
teen subjects (mean age 44 yrs) with different degrees of renal functi
on: group 1, creatinine clearance (Cl-cr) below 10 ml/minute; group 2,
Cl-cr 10-50 ml/minute; and group 3, Cl-cr greater than SO ml/minute (
6 patients in each group). Intervention. Over 5-7 days, 15 serum sampl
es were collected after a single intravenous dose of digoxin 7 or 10 m
u g/kg actual body weight (WT) for serum concentration measurements by
FPIA. Two-compartment pharmacokinetic parameters (zero-rime intercept
of the concentration-time curve of the initial distribution phase [A]
, zero-lime intercept of the concentration-lime curve of the terminal
elimination phase [B], initial distribution phase constant [alpha], te
rminal elimination rate constant [beta], volume of distribution in the
central compartment [V-c] and at steady slate [V-c], total body clear
ance [Cl], mean residence time [MRT], area under the concentration-rim
e curve [AUC]) were determined using a nonlinear least squares regress
ion program. Measurements and Main Results. No significant differences
were found among groups for A, B, alpha, beta, beta-half-life, V-c/WT
, MRT, AUG, and Cl/WT. Significant differences were observed in V-ss/W
T (4.8 +/- 1.0, 6.6 +/- 0.5, 6.4 +/- 0.7 L/kg) between group I versus
group 2 and group 1 versus group 3 (p<0.01). Measured Cl-cr was correl
ated with Cl (r(2)=0.40, p<0.01), Cl/WT (r(2)=0.29, p<0.05), V-ss (r(2
)=0.35, p=0.01), and V-ss/WT (r(2)=0.24, p<0.05). Conclusion. This stu
dy confirmed that V-ss is smaller in patients with chronic renal failu
re (Cl-cr < 10 ml/min) than those without chronic renal failure. There
fore, previous recommendations that lower digoxin loading doses should
be administered in patients with renal failure are applicable to digo
xin serum concentration monitoring using FPIA.