Appropriate pharmacokinetic parameters for designing the dosage regimen of digoxin in Thai patients
Main Article Content
Abstract
Digoxin is a cardiac glycoside which one of the most frequently prescribed drug, especially in the treatment of atrial fibrillation and congestive heart failure. The drug has narrow therapeutic index, complicate pharmacokinetics and the dose relates to toxicity. This study was analytical retrospective study which use the parameters from pharmacokinetic parameters in Thai population at Queen Sirikit Heart Center and Srinakarind Hospital, Khon Kaen, in previous study such as CL/F (L/h) = 0.122*CrCL, Ke (-1hr) = 1.93 and Vd/F (L) = 403, compared with the general parameters for designing appropriate regimen of digoxin in Thai patients. The study performed in 51 Thai patients, 127 digoxin blood samples, which the aged of 20-65 years old with serum creatinine levels (SCr). The concentrations calculated from the two types of parameters were compared. The result found that the serum concentrations calculated from population pharmacokinetic parameters in Thai patient could estimate more accurate than calculated from general parameters (MSE 1.01 and 1.85, respectively). Moreover, The 36 of 51 patients had creatinine clearance (CrCL) in the range of 33.38-86.70 ml/min were found that the estimated concentrations were closer to the measured concentrations. In 36 patients (83 samples) were more accurate than total of 51 patients used parameters from population pharmacokinetics and parameters from general study (MSE = 0.89, 1.01 and 1.53, respectively). The finding was concluded that the parameters from population pharmacokinetics in Thai patients could be used to calculate serum concentration at steady state (Css), estimated loading dose (LD) and maintenance dose (MD) more accurate than the general parameters especially in Thai patients who had the characteristics of diagnosed cardiac disease, 20-65 years old, measured serum creatinine and CrCL range of 33.38 - 86.70 ml/min.
Article Details
In the case that some parts are used by others The author must Confirm that obtaining permission to use some of the original authors. And must attach evidence That the permission has been included
References
Cheungsirakulvit S. Population pharmacokinetic study of digoxin in patients in Sisaket hospital. (Dissertation). Khon Kaen, University of Khon Kaen. 2000:131.
Lacy CF, Armstrong LL, Goldman MP, Lance LL. Drug information handbook international 19th edition. Ohio, USA: Lexi-comp. 2010-2011: 443-6.
Nagaraja NV, Park YJ, Jeon S, Sands CD, Derendorf H. Population pharmacokinetics of digoxin in Korean patients. Int J Clin Pharmacol Ther. 2000; 38(6): 291-7.
Nakajud P, Preechagoon Y, Wongwipaporn C, Ariyapim N. Population pharmacokinetic analysis of digoxin for designing appropriate dosage regimen in Thai patients. The 3rd Annual Northeast Pharmacy Research Conference 2011: 142-9.
Nakamura T, Kakumoto M, Yamashita K, Takara K,Tanigawara Y, Sakaeda T, et al. Factors Influencing the Prediction of Steady State Concentrations of Digoxin. Biol Pharm Bull. 2001; 24: 403-8.
Preechagoon Y, Somsaard P, and Petcharattana S. Population Pharmacokinetics of Digoxin in Thai Pediatric Patients. J Med Assoc Thai. 2009; 92(10): 1324-35.
Sheiner LB, Rosenberg B, Marathe VV. Estimation of population characteristics of pharmacokinetic parameters from routine clinical data. Jounal of Pharmacokinetics and Pharmacodynamic.1997; 5: 445-79.
Tatro DS. Drug interaction facts 2011. Wolters Kluwer Health: Facts and comparison. 2011: 625-77.
Yukawa E, Mine H, Higuchi S, Aoyama T.Digoxin Population Pharmacokinetics from Routine Clinical Data: Role of Patient Characteristics for Estimating Dosing Regimens. J Pharm Pharmacol.1992; 44:761–5.
Yukawa E, Honda T, Ohdo S, Higuchi S, Aoyama T. Population-based investigation of relative clearance of digoxin in Japanese patients by multiple trough screen analysis: an update. J Clin Pharmacol. 1997; 37: 92-100.
Yukawa E, Suematu F, Yukawa M, Minemoto M, Ohdo S, Higuchi S et al. Population Pharmacokinetics of Digoxin in Japanese Patients A 2-Compartment Pharmacokinetic Model. Clin Pharmacokinet. 2001; 40: 773-81.
Zhou X, Guan Z, Li Z, Li J. Population pharmacokinetic model of digoxin in older Chinese patients and its application in clinical practice. Acta Pharmacol Sin. 2001; 31: 753–8