Back to the Top
Our pharmacists would like to find guidelines for digoxin dosing and
creatinine clearance. We would appreciate it if anyone can tell us
where we can find this.
Thank you,
B. Miers
Methodist Med Ctr.
Peoria, Il
Back to the Top
B. Miers
Methodist Med Ctr.
Peoria, Il
"Drug Prescribing in Renal Failure: Dosing Guidelines
for Adults", Bennett WM, Aronoff GR, Golper TA, et al.
Third Edition. American College of Physicians.
Philadelphia, PA. 1994.
"Drug Dosage in Renal Insufficiency", Seyffart G.
Kluwer Academic Publishers. Norwell, MA. 1991.
Both sources have specific references.
G. Aronoff, M.D.
Kidney Disease Program
University of Louisville School of Medicine
graron01.at.ulkyvm.louisville.edu
Back to the Top
Miers,
The dosing of digoxin in renal pts and those with liver disease or CHF is
not straight forward. However, some useful information maybe found in a
little book by JR White and MW Garrison entitled Basic Clinical
Pharmacokinetics Handbook (it sounds bigger than it really is)
(by Applied Therapeutics, inc; phone6-253-7123)
Here are some basic steps:
1 - Determine the size of the loading dose.
Vd x desired level x bioavailability (F)
(Vd and F vary depending on pt condition)(therp level depends on
whether
we are treating CHF or arrhythmia)
The loading dose is usually 10 to 15 Ug/kg.
The total loading dose is usually divided into 50%, 25%, 25% parts given 6
hrs apart.
2 - Estimate the percent daily elimination (%E). This may be done using the
Jelliffe method: %E = 0.2 CLcr + 14 ; where CLcr=estimated creatinine
clearance in mL/min.
3 - Daily maintenance dose = %E x Loading Dose
However, in practice dosing is adjusted according to clinical response
(therapeutic and adverse effects) and serum level.
I hope this useful.
Nasr Anaizi, PhD RPh
Univ. of Rochester Medical Center
Back to the Top
Try the Third Edition of Michael Winter's Basic Clinical
Pharmacokinetics. You should find it very helpful
PharmPK Discussion List Archive Index page
Copyright 1995-2010 David W. A. Bourne (david@boomer.org)