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Special Populations Race differences in digoxin pharmacokinet-ics have not been formally studied. Because digoxin is primarily elim-inated as unchanged drug via the kidney and because there are no important differences in creatinine clearance among races, pharma-cokinetic differences due to race are not expected. The clearance of digoxin can be primarily correlated with renal function as indicated by creatinine clearance. The Cockcroft and Gault formula for estimation of creatinine clearance includes age, body weight, and gender. A table that provides the usual daily main-tenance dose requirements of digoxin tablets based on creatinine clearance (per 70 kg) is presented in the DOSAGE AND ADMINISTRA- TION section. Plasma digoxin concentration profiles in patients with acute hepatitis generally fell within the range of profiles in a group of healthy subjects. Text Continues Below
Pharmacodynamic and Clinical Effects The times to onset of phar-macologic effect and to peak effect of preparations of digoxin are shown in Table 2: Table 2: Times to Onset of Pharmacologic Effect and to Peak Effect of Preparations of Digoxin
*Documented for ventricular response rate in atrial fibrillation, inotropic effects and electrocardiographic changes. * Depending upon rate of infusion. Hemodynamic effects Digoxin produces hemodynamic improvement in patients with heart failure. Short-and long-term therapy with the drug increases cardiac output and lowers pulmonary artery pressure, pulmonary capillary wedge pressure, and systemic vascular resist-ance. These hemodynamic effects are accompanied by an increase in the left ventricular ejection fraction and a decrease in end-systolic and end-diastolic dimensions. Chronic Heart Failure Two 12-week, double-blind, placebo-con-trolled studies enrolled 178 (RADIANCE trial) and 88 (PROVED trial) patients with NYHA class II or III heart failure previously treated with digoxin, a diuretic, and an ACE inhibitor (RADIANCE only) and ran-domized them to placebo or treatment with digoxin. Both trials demonstrated better preservation of exercise capacity in patients randomized to digoxin. Page: << Prev | 1 | 2 | 3 | 4 | 5 | Next >>
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