Pharmacy World and Science

, Volume 15, Supplement 1, pp 29–33 | Cite as

Evaluation of two prediction models for digoxin dosing

  • Sophia L. Markantonis
  • Asterios Kyroudis
  • Theodoros Christopoulos


The relationship between the digoxin elimination parameter (A%) and creatinine clearance (CLCr) was determined, from blood level data of 160 hospital patients receiving digoxin tablets. The linear regression equation obtained, which varied only slightly from that reported by Jelliffe previously, was used to predict serum digoxin concentrations in 140 patients of four age groups (50–60, 60–70, 70–80 and 80–90 years). The predictions made were found to be less biased and more precise, irrespective of the age of the patients, than those produced using another predictive method known as Dobbs method. However, correlation coefficients of predicted versus measured serum digoxin concentrations for each method did not differ significantly and frequency distribution analyses of prediction errors gave poor results (up to 63% only). Therefore, neither method can be considered to be superior to the other nor can they be said to ensure accurate predictions of serum digoxin concentrations.


Blood level Clearance Creatinine Digoxin Dosage Prediction models 


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  1. 1.
    Aronson JK. Indication for the measurement of plasma digoxin concentrations. Drugs 1983;26:230–42.PubMedGoogle Scholar
  2. 2.
    Wagner JG, Yates JD, Willis PW, Sakmar E, Stoll RG. Correlation of plasma levels of digoxin in cardiac patients with dose and measures of renal function. Clin Pharmacol Ther 1974;15:291–301.PubMedGoogle Scholar
  3. 3.
    Koup JR, Jusko WJ, Elwood CM, Kohli RK. Digoxin pharmacokinetics: role of renal failure in dosage regimen design. Clin Pharmacol Ther 1975;18:9–21.PubMedGoogle Scholar
  4. 4.
    Jones WN, Perrier D, Trinca CE, Hager WD, Conrad K. Evaluation of various methods of digoxin dosing. J Clin Pharmacol 1982;22:543–50.PubMedGoogle Scholar
  5. 5.
    Dettli L. The kidney in pre-clinical and clinical pharmacokinetics. Jpn J Clin Pharmacol Ther 1984;15:241–54.Google Scholar
  6. 6.
    Jelliffe RW. Administration of digoxin. Dis Chest 1969;56:56–60.PubMedGoogle Scholar
  7. 7.
    Dobbs SM, Mawer GE, Rodgers EM, Woodcock BG, Lucas SB. Can maintenance digoxin dose requirements be predicted? Br J Clin Pharmacol 1976;3:231–7.PubMedGoogle Scholar
  8. 8.
    Jelliffe RW, Brooker G. A nomogram for digoxin therapy. Am J Med 1974;57:63–8.PubMedGoogle Scholar
  9. 9.
    Aronson JK. Monitoring digoxin therapy. III How useful are the nomograms? Br J Clin Pharmacol 1978;5:55–64.PubMedGoogle Scholar
  10. 10.
    Hooymans PM, Merkus FWHM, Pluym BFM, Bongarts J, Hoeksema D, Overdiek H. Prediction of digoxin dose requirement. Clin Pharmacol Ther 1980;27:258–64.Google Scholar
  11. 11.
    Hyneck ML, Johnson MH, Wagner JG, Williams GW. Comparison of methods for estimating digoxin dosing regimens. Am J Hosp Pharm 1981;38:69–73.PubMedGoogle Scholar
  12. 12.
    Sheiner LB, Beal SL. Some suggestions for measuring predictive performance. J Pharmacokinet Biopharm 1981; 9:503–12.PubMedGoogle Scholar
  13. 13.
    Lalonde RL, Pao D. Correlation coefficient versus prediction error in assessing the accuracy of digoxin dosing methods. Clin Pharm 1984;3:178–83.PubMedGoogle Scholar
  14. 14.
    Jelliffe RW. A mathematical analysis of digitalis kinetics in patients with normal and reduced renal function. Math Biosc 1967;1:305–25.Google Scholar
  15. 15.
    Tozer TN. Nomogram for modification of dosage regimens in patients with chronic renal function impairment. J Pharmacokinet Biopharm 1974;2:13–28.Google Scholar
  16. 16.
    Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16:31–41.PubMedGoogle Scholar
  17. 17.
    Devine BJ. Gentamicin therapy. Clinical pharmacy case studies. Drug Intell Clin Pharm 1974;8:650–5.Google Scholar
  18. 18.
    Rich DS, Pinkus TF, Jeffrey LP. Estimating the volume of distribution of digoxin [published erratum appears in Am J Hosp Pharm 1981;38:1127]. Am J Hosp Pharm 1981;38:631–2.Google Scholar
  19. 19.
    Notari RE. Biopharmaceutics and clinical pharmacokinetics. New York: Marcel Dekker, 1980:174–211,D:348–350.Google Scholar
  20. 20.
    Perrin CJ. Mathematics for chemists. New York: Wiley Interscience, 1970:12–3.Google Scholar
  21. 21.
    Rowe JW, Andres R, Tobin JD. The effect of age in creatinine clearance in man. A cross-sectional and longitudinal study. J Gerontol 1976;31:155–63.PubMedGoogle Scholar
  22. 22.
    Johnston GD, McDevitt DG. Is maintenance digoxin necessary in patients with sinus rhythm? Lancet 1979; 1:567–70.PubMedGoogle Scholar

Copyright information

© Periodicals Service Company 1993

Authors and Affiliations

  • Sophia L. Markantonis
    • 1
  • Asterios Kyroudis
    • 2
  • Theodoros Christopoulos
    • 2
  1. 1.The Apollo TowerAthensGreece
  2. 2.Clinical Pharmacokinetics UnitThe Army Share Fund Hospital (NIMTS)AthensGreece

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