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Dig
ital
is p
har
mac
oki
net
ics/
met
abo
lism
R
enal
fu
nct
ion
C
ard
iac
gly
cosi
des
D
lgo
xin
D
igit
oxi
n
Ou
abai
n
Dig
ital
is r
esis
tan
ce/s
ensi
tivR
y D
igit
alis
ass
ay
Car
dia
c g
lyco
sid
es
Imm
un
oas
say
An
tib
od
ies
h4a
rcu
s FI:
Dig
ital
is p
har
mac
oki
net
ics
and
m
etab
olis
m.
Am
J
Med
58
: 45
2-45
9,
1975
. B
utl
er V
P J
r, L
ind
enb
aum
J:
Ser
um
dig
ital
is m
easu
rem
ents
in
th
e as
sess
men
t o
f d
igi-
ta
lis r
esis
tan
ce
and
sen
siti
vity
. Am
J f
vled
58:
460
-469
, 19
75.
Dig
oxi
n c
an
accu
mu
late
in
th
e b
od
y w
ith
ou
t th
e ad
min
istr
atio
n
of
a lo
adin
g d
ose
, an
d
a st
ead
y st
ate
blo
od
co
nce
ntr
atio
n w
ill b
e re
ach
ed
in 5
to
7 d
ays.
Dig
ito
xin
req
uir
es 3
5 d
ays
to
accu
mu
late
to
a p
late
au.
If a
lo
adin
g d
ose
of
dig
oxi
n i
s u
sed
, it
sh
ou
fd b
e ab
ou
t th
ree
tim
es
the
esti
mat
ed d
aily
mai
nte
nan
ce
do
se.
Fac
tors
th
at d
eter
min
e th
e se
lect
ion
of
the
app
rop
ri-
ate
mai
nte
nan
ce
do
se o
f d
igo
xin
incl
ud
e re
nal
fu
nct
ion
an
d l
ean
bo
dy
mas
s.
Dig
ito
xin
is
no
t as
dep
end
ent
on
ren
al f
un
ctio
n f
or
its
elim
inat
ion
as
dig
oxi
n.
Th
ere
sho
uld
be
a la
pse
of
3 d
ays
bef
ore
st
arti
ng
dig
oxi
n t
her
apy
wh
en c
han
gin
g f
rom
m
ain
ten
ance
d
igtt
oxi
n to
dig
oxi
n.
Th
e p
har
mac
oki
net
ics
of
chan
gin
g f
rom
ou
abai
n t
o d
igo
xin
wit
ho
ut
loss
of
dig
ital
is e
ffec
t ar
e d
escr
ibed
. T
he
met
abo
lism
of
the
com
mo
nly
use
d d
igit
alis
pre
par
atio
ns
are
sum
mar
ized
.
Th
ese
auth
ors
des
crib
e th
e d
evel
op
men
t an
d c
linic
al a
pp
licat
ion
of
imm
un
olo
gic
ass
ays
for
card
iac
gly
cosi
des
wit
h s
pec
ial
emp
has
is o
n th
e ro
le w
hic
h a
kn
ow
led
ge
of
the
seru
m d
igit
al-
is c
on
cen
trat
ion
, n
ow
so
rea
dily
ava
ilab
le,
has
pla
yed
in
en
ablin
g u
s to
dev
elo
p s
ou
nd
pri
nci
- p
les
for
a m
ore
ra
tio
nal
ap
pro
ach
to
th
e cl
inic
al a
dm
inis
trat
ion
of
this
dru
g,
par
ticu
larl
y in
ce
rtai
n
pat
ien
ts w
ith
un
usu
ally
lar
ge
do
sag
e re
qu
irem
ents
o
r w
ith
un
usu
al s
ensi
tivi
ty t
o r
ela-
ti
vely
sm
all
do
ses
of
dig
ital
is g
lyco
sid
es.
Dig
ital
is t
oxi
city
C
ard
iac
gly
cosi
des
D
igo
xin
A
nti
arrh
yth
mic
d
rug
s P
har
mac
oki
net
ics
Ph
arm
aco
dyn
amic
s
Diii
toxi
n
Ser
um
dig
ital
is c
on
cen
trat
ion
C
ard
iac
dis
ease
C
ard
iova
scu
lar
ther
apy
Car
dia
c ar
rhyt
hm
ias
Sm
ith
TW
: D
igtt
alis
to
xici
ty:
epid
emio
log
y an
d c
linic
al u
se
of
seru
m
con
cen
trat
ion
m
easu
rem
ents
. A
m J
Med
56:
470
-476
, 19
75.
Big
ger
JT
Jr:
Ph
arm
aco
log
ic
and
clin
ical
co
ntr
ol
of
anti
arrh
yth
mic
d
rug
s. A
m J
Med
58
: 47
9-48
8,
1975
.
Stu
die
s in
dic
ate
that
mea
n d
igo
xin
an
d d
igit
oxi
n le
vels
are
sig
nif
ican
tly
hig
her
in
pat
ien
ts w
ith
el
ectr
oca
rdio
gra
ph
ic
evid
ence
of
toxi
city
th
an i
n p
atie
nts
wit
ho
ut
such
evi
den
ce.
Bec
ause
o
f th
e o
verl
ap i
n s
eru
m d
igit
alis
co
nce
ntr
atio
ns
and
th
e m
ult
ifac
tori
al n
atu
re o
f d
igit
alis
into
xica
- tt
on
, so
le d
epen
den
ce
on
th
ese
leve
ls f
or
esta
blis
hin
g a
dia
gn
osi
s o
f d
igit
alis
to
xici
ty i
s n
ot
war
ran
ted
. S
eru
m l
evel
dat
a sh
ou
ld b
e as
sess
ed
in t
he
full
clin
ical
co
nte
xt.
Typ
e an
d e
xten
t o
f u
nd
erly
ing
car
dia
c d
isea
se a
re p
arti
cula
rly
imp
ort
ant
det
erm
inan
ts
of
the
resp
on
se t
o a
ny
giv
en s
eru
m o
r m
yoca
rdiil
d
igit
alis
co
nce
ntr
atio
n.
Mea
sure
men
t o
f se
rum
car
dia
c g
tyco
sid
e co
nce
ntr
atio
n m
ay b
e u
sefu
l wh
enev
er a
n u
nan
tici
pat
ed r
esp
on
se t
o t
hes
e d
rug
s (e
ith
er s
us-
p
ecte
d t
oxi
city
or
abse
nce
of
an e
xpec
ted
th
erap
euti
c ef
fect
) is
en
cou
nte
red
.
Kn
ow
led
ge
of
ph
arm
aco
kin
etlc
s an
d p
har
mac
od
ynam
ics
is a
p
ow
erfu
l to
ol
for
con
tro
llin
g
card
iac
arrh
yth
mia
s w
ith
dru
gs
even
th
ou
gh
an
tiar
rhyt
hm
ic d
rug
s ar
e p
ote
nti
ally
qu
ite
toxi
c. I
f th
e d
iag
no
sis
and
dru
g s
elec
tio
n a
re
corr
ect
at t
he
ou
tset
of
ther
apy,
th
e cl
inic
ian
can
u
se
his
kn
ow
led
ge
of
ph
arm
aco
kin
etic
s to
ach
ieve
ar
rhyt
hm
ia c
on
tro
l w
ith
a m
inim
um
of
per
son
- al
eff
ort
an
d r
isk
to t
his
pat
ien
t.
D z
