Plasma digoxin levels and ejection fraction in pediatric heart failure

  • Nafrialdi Nafrialdi Department of Pharmacology and Therapeutics, University of Indonesia Medical School/ Dr. Cipto Mangunkusumo Hospital, Jakarta.
  • Sake Juli Martina Department of Pharmacology and Therapeutics, University of Indonesia Medical School/ Dr. Cipto Mangunkusumo Hospital, Jakarta.
  • Mulyadi Djer Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta.
  • Melva Louisa Department of Pharmacology and Therapeutics, University of Indonesia Medical School/ Dr. Cipto Mangunkusumo Hospital, Jakarta.
Keywords: plasma digoxin level; ejection fraction; digoxin

Abstract

Background Digoxin has long been prescribed in children with heart failure, but its efficacy has not been evaluated. A previous study at the Department of Child Health, Dr. Cipto Mangunkusumo Hospital revealed that plasma digoxin levels, following a maintenance dose of 15 μg/kg/d, were sub-therapeutic. Regarding its narrow margin of safety, the trend is to use digoxin in even lower dose. Thus, the drug’s impact on cardiac performance need to be evaluated. Objective To evaluate whether a lower maintenance dose of digoxin (10 μg/kg/d) is sufficient to achieve a therapeutic level and to assess for possible correlations between plasma digoxin level and left ventricular ejection fraction (LVEF) as well as fractional shortening (LVFS). Methods A cross-sectional study was conducted on 20 pediatric heart failure patients at the Department of Child Health, Dr. Cipto Mangunkusumo Hospital, Jakarta, from January to May 2012. Plasma digoxin levels were measured by ELISA method after one month or more of treatment; LVEF and LVFS were measured by echocardiography. Correlations between plasma digoxin level and LVEF or LVFS were analyzed by Spearman’s correlation test. The LVEF before and after digoxin treatment were compared by paired T-test. Results Thirteen out of 20 patients had plasma digoxin levels within therapeutic range (0.5-1.5 ng/mL; 95%CI 0.599 to 0.898) and 7 had sub-therapeutic levels (<0.5 ng/ mL; 95%CI 0.252 to 0.417). No significant correlations were observed between plasma digoxin level and LVEF (r=-0.085; P=0.722) or LVFS (r=-0.105; P=0.659). There was a significant increase in LVEF before [42.18 (SD 14.15)%] and after digoxin treatment [57.52 (SD 11.09)%], (P < 0.0001). Conclusion Most patients in this study have plasma digoxin levels within therapeutic range. There are no significant correlations between plasma digoxin level at the time point of measurement and LVEF or LVFS. However, an increase of LVEF is observed in every individual patients following digoxin treatment.

References

Hsu DT, Pearson GD. Heart failure in children: Part I: History, etiology and pathophysiology. Circ Heart Fail. 2009;2:63- 70.

Andrews RE, Fenton MJ, Ridout DA, Burch M. New-onset heart failure due to heart muscle disease in childhood: a prospective study in the United Kingdom and Ireland. Circulation. 2008;117:79-84.

Kay JD, Colan SD, Graham TP Jr. Congestive heart failure in pediatric patients. Am Heart J. 2001;142:923-8.

Lipshultz SE. Ventricular dysfunction clinical research in infants, children and adolescents. Prog Pediatr Cardiol. 2000;12:1-28.

Nahata MC, Taketomo C. Pediatrcs. In: Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, editors. Pharmacotherapy, a pathophysiologic approach. 7th ed. NewYork: McGraw-Hill; 2008. p. 192-3.

Opie LH, Wilson PA. Digitalis, acute inotropes, and inotropic dilators. Acute and chronic heart failure. In: Opie LH, Gersh BJ, editors. Drug for the heart. 6th ed. Philadelphia: Saunders Elsevier; 2005. p. 149-83.

White RJ, Chamberlain DA, Howard M, Smith TW. Plasma concentration of digoxin after oral administration in the fasting and postprandial state. Br Med J. 1971;1:380-1.

Brunton L, Parker K, Blmenthal D, Buxton L, editors. Goodman and Gilman’s pharmacological basis of therapeutics. New York: McGraw-Hill; 2008. p. 561-77.

Nahata MC, Taketomo C. Pediatrics. In: Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, editors. Pharmacotherapy, a pathophysiologic approach. 7th ed. New York: McGraw-Hill; 2008. p. 4-54.

Madiyono B. Pemantauan kadar digoksin pada pasien penyakit jantung reumatik dengan gagal jantung. Jurnal Kardiologi Indonesia. 1994;19:200-6.

Maron BA, Rocco TP. Pharmacotherapy of congestive heart failure. In: Brunton LL, Chabner BA, Knollmann BC, editors. Goodman & Gilman’s: the pharmacological basis of therapeutics. 12th ed. New York: McGraw-Hill; 2011. p. 789-813.

Robertson LW, Chandrasekaran A, Reuning RH, Hui J, Rawal BD. Reduction of digoxin to 20 r-dihydroxydigoxin by cultures of Eubacterium lentum. Appl Environ Microbiol. 1986;51:1300-03.

Katzung BG. Drugs used in heart failure. In: Katzung BG, Masters SB, Trevor AJ, editors. Basic and clinical pharmacology. 12th ed. New York: McGraw-Hill; 2010. p. 211-25.

Poole-Wilson PA, Opie LH. Digitalis, acute inotropes, and inotropic dilators. Acute and chronic heart failure. In: Opie LH, Gersh BJ, editors. Drugs for the heart. 6th ed. New York: Elsevier-Saunders; 2005. p. 149-83.

Published
2016-11-30
How to Cite
1.
Nafrialdi N, Martina S, Djer M, Louisa M. Plasma digoxin levels and ejection fraction in pediatric heart failure. PI [Internet]. 30Nov.2016 [cited 12Oct.2024];55(6):322-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/65
Received 2016-02-12
Accepted 2016-02-12
Published 2016-11-30