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首页> 外文期刊>Internal medicine journal >Frequently discordant results from therapeutic drug monitoring for digoxin: Clinical confusion for the prescriber
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Frequently discordant results from therapeutic drug monitoring for digoxin: Clinical confusion for the prescriber

机译：地高辛治疗药物监测结果不一致：开药者的临床困惑

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Background: Digoxin remains a commonly prescribed medication for the treatment of congestive cardiac failure or atrial tachyarrhythmias. Its utility is offset by its narrow therapeutic index requiring regular blood concentration monitoring. Recent evidence suggests that a lower therapeutic range (0.5-0.8 μg/L, or 0.6-1.0 nmol/L) is associated with reduced mortality in patients with congestive cardiac failure. Therapeutic drug monitoring for digoxin is carried out by immunoassays that are well established in routine clinical practice. Laboratories using different immunoassays may be involved in monitoring individual patients throughout the protracted course of therapy. These results should be concordant to ensure consistent dose individualization and optimum clinical management. We have investigated the discordance in digoxin measurements involving five different laboratories across the Adelaide metropolitan area. Methods: Aliquots from routine digoxin samples (n = 261) were analysed by accredited laboratories using commercially available immunoassays. Results: The results showed that 119 (46%) of 261 samples were so varied that a different clinical outcome was indicated when reviewed by the treating physician. The differences between the highest and lowest readings from any one sample were also substantial, with 45% of the measurements exceeding 0.3 μg/L. Conclusions: Our study shows the considerable variation in the routine monitoring of digoxin. This makes therapeutic drug monitoring difficult to interpret and complicates clinical management when treating physicians are endeavouring to avoid toxicity and optimize dosing. These results raise a significant concern for the quality of therapeutic drug monitoring of digoxin and have direct repercussions on patient care.
机译：背景：地高辛仍然是治疗充血性心力衰竭或房性快速性心律失常的常用处方药。它的实用性被需要定期监测血液浓度的狭窄治疗指数所抵消。最近的证据表明，较低的治疗范围（0.5-0.8μg/ L或0.6-1.0 nmol / L）与充血性心力衰竭患者的死亡率降低相关。地高辛的治疗药物监测通过常规临床实践中公认的免疫测定法进行。在整个治疗过程的长期过程中，可能需要使用不同免疫测定方法的实验室来监视单个患者。这些结果应一致，以确保一致的剂量个性化和最佳的临床管理。我们已经调查了涉及阿德莱德都会区五个不同实验室的地高辛测量中的不一致。方法：由认可的实验室使用市售的免疫测定法分析常规地高辛样品（n = 261）的等分试样。结果：结果显示261个样本中有119个（46％）变化如此之大，以至于由主治医师检查时显示出不同的临床结果。任何一个样品的最高和最低读数之间的差异也很大，其中45％的测量值超过0.3μg/ L。结论：我们的研究表明地高辛的常规监测存在很大差异。当治疗医师努力避免毒性并优化剂量时，这使得治疗药物监测难以解释，并使临床管理变得复杂。这些结果引起对地高辛治疗药物监测质量的重大关注，并对患者护理产生直接影响。

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