Correlation of plasma levels of digoxin in cardiac patients with dose and measures of renal function

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Abstract
There is a well‐established relationship between plasma concentrations of digoxin (PDC's) and therapeutic and toxic effects. The readily obtainable parameters, namely, dose, body weight, age, sex, and creatinine clearance or serum creatinine concentration, might be expected to allow accurate prediction of PDC's. We have now found that these parameters do not allow accurate prediction of PDC's in the individual patient, based on data collected in a panel of cardiac patients. Serial measurements of PDC's are therefore necessary in individual patients taking digoxin. These conclusions are based onL he following results. Forty‐eight equilibrium state PDC's were measured in 25 patients (13 males, 12 females) both under ward conditions (N = 11) and in the Clinical Research Center (N = 27). Multiple linear regression accounted for only 34% of the variance of the PDC's. Individual variables accounted for the following percentages of the total variance of the PDC's: dose, 14.3%; serum creatinine concentration, 10.9%; reciprocal of body weight, 3.1%; reciprocal of urinary excretion rate of creatinine, 0.9%; age, 0.7%, and height, 0.02%. Practically, the digoxin level (ng/ml) is equal to one fifth of the product of the μ/kg dose of digoxin and the serum creatinine concentration in mg/100 ml. Such a correlation accounts for only about one third of the variance of the PDC's; hence predicted levels have a wide confidence interval.

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