HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

The role of digitalis pharmacokinetics in converting atrial fibrillation and flutter to regular sinus rhythm.

Abstract
This report examined the role of digitalis pharmacokinetics in helping to guide therapy with digitalis glycosides with regard to converting atrial fibrillation (AF) or flutter to regular sinus rhythm (RSR). Pharmacokinetic models of digitoxin and digoxin, containing a peripheral non-serum effect compartment, were used to analyze outcomes in a non-systematic literature review of five clinical studies, using the computed concentrations of digitoxin and digoxin in the effect compartment of these models in an analysis of their outcomes. Four cases treated by the author were similarly examined. Three literature studies showed results no different from placebo. Dosage regimens achieved ≤11 ng/g in the model's peripheral compartment. However, two other studies achieved significant conversion to RSR. Their peripheral concentrations were 9-14 ng/g. In the four patients treated by the author, three converted using classical clinical titration with incremental doses, plus therapeutic drug monitoring and pharmacokinetic guidance from the models for maintenance dosage. They converted at peripheral concentrations of 9-18 ng/g, similar to the two studies above. No toxicity was seen. Successful maintenance was achieved, using the models and their pharmacokinetic guidance, by giving somewhat larger than average recommended dosage regimens in order to maintain peripheral concentrations present at conversion. The fourth patient did not convert, but only reached peripheral concentrations of 6-7 ng/g, similar to the studies in which conversion was no better than placebo. Pharmacokinetic analysis and guidance play a highly significant role in converting AF to RSR. To the author's knowledge, this has not been specifically described before. In my experience, conversion of AF or flutter to RSR does not occur until peripheral concentrations of 9-18 ng/g are reached. Results in the four cases correlated well with the literature findings. More work is needed to further evaluate these provocative findings.
AuthorsRoger W Jelliffe
JournalClinical pharmacokinetics (Clin Pharmacokinet) Vol. 53 Issue 5 Pg. 397-407 (May 2014) ISSN: 1179-1926 [Electronic] Switzerland
PMID24671885 (Publication Type: Case Reports, Journal Article, Research Support, N.I.H., Extramural)
Chemical References
  • Anti-Arrhythmia Agents
  • Digoxin
  • Digitoxin
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Arrhythmia Agents (administration & dosage, blood, pharmacokinetics)
  • Atrial Fibrillation (blood, drug therapy, physiopathology)
  • Atrial Flutter (blood, drug therapy, physiopathology)
  • Digitalis
  • Digitoxin (administration & dosage, blood, pharmacokinetics)
  • Digoxin (administration & dosage, blood, pharmacokinetics)
  • Female
  • Humans
  • Male
  • Middle Aged
  • Models, Biological

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: