Digoxin Testmiljö
Digoxin
Klass : C
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Digoxin, Digoxin Evolan, Digoxine Nativelle, Lanicor, Lanoxin, Lanoxin......
Digoxin, Digoxin Evolan, Digoxine Nativelle, Lanicor, Lanoxin, Lanoxin PG Elixer, Lanoxin PG Elixir, Lenoxin LiquidumATC-koder
C01AA05
C01AA05Substanser
digoxin
digoxinSammanfattning
Kvinnor med hjärtsvikt har en ökad risk för mortalitet vid behandling med digoxin. Ökad serumkoncentration hos kvinnor på grund av relativt lägre njurutsöndring av digoxin har diskuterats som orsak. Njurfunktionen måste dock alltid beaktas, i synnerhet hos äldre kvinnor med låg kroppsvikt.
Det finns beskrivet en ökad fallrisk hos män som behandlats med digoxin.
Background
Pharmacokinetics and dosing
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The renal clearance of digoxin is reported to be around 12-14% lower in women than men [1, 2]. However, the difference is not considered to be clinically important [2]. As the therapeutic window is narrow, digoxin is mainly eliminated vi the kidneys, and renal clearance generally is lower in women, therapeutic drug monitoring of digoxin and dosage adjustment may be necessary. However, a small retrospective review of medical records (32 men, 35 women) report that the pharmacokinetics of digoxin do not appear to differ by sex [3].
Effects
The mortality risk from digoxin in atrial fibrillation treatment was similar in men and women in a large clinical trial (AFFIRM, 2466 men, 1594 women) [7] and a cohort study (ATIR-CVRN, 15191 men, 12097 women) [8].
A post-hoc subgroup analysis of the Digitalis Investigation Group (DIG) trial (5281 men, 1519 women) showed that digoxin therapy compared with placebo in heart failure was associated with increased all-cause mortality in women, but not in men [4]. This result is controversial because a sub-group analysis of......
Försäljning på recept
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Fler kvinnor än män hämtade ut läkemedel innehållande digoxin (ATC-kod C01AA05) på recept i Sverige år 2017, totalt 21 579 kvinnor och 18 997 män. Det motsvarar 4,3 respektive 3,8 personer per tusen invånare. Andelen som hämtat ut läkemedel ökade med stigande ålder hos båda könen. I åldersgruppen yngre än 80 år var läkemedel innehållande digoxin i genomsnitt 2,1 gånger vanligare hos män medan i åldersgruppen 80 år och äldre var det i genomsnitt 1,2 gånger vanligare hos kvinnor [19].
Referenser
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Yukawa E, Honda T, Ohdo S, Higuchi S, Aoyama T. Population-based investigation of relative clearance of digoxin in Japanese patients by multiple trough screen analysis: an update. J Clin Pharmacol. 1997;37:92-100.
LANOXIN (digoxin). DailyMed [www]. US National Library of Medicine. [updated 2018-08-31, cited 2019-02-11].
Lee LS, Chan LN. Evaluation of a sex-based difference in the pharmacokinetics of digoxin. Pharmacotherapy. 2006;26:44-50.
Rathore SS, Wang Y, Krumholz HM. Sex-based differences in the effect of digoxin for the treatment of heart failure. N Engl J Med. 2002;347:1403-11.
Domanski M, Fleg J, Bristow M, Knox S. The effect of gender on outcome in digitalis-treated heart failure patients. J Card Fail. 2005;11:83-6.
Lupón J, Urrutia A, González B, Díez C, Altimir S, Albaladejo C et al. Does heart failure therapy differ according to patient sex?. Clin Cardiol. 2007;30:301-5.
Whitbeck MG, Charnigo RJ, Khairy P, Ziada K, Bailey AL, Zegarra MM et al. Increased mortality among patients taking digoxin--analysis from the AFFIRM study. Eur Heart J. 2013;34:1481-8.
Freeman JV, Reynolds K, Fang M, Udaltsova N, Steimle A, Pomernacki NK et al. Digoxin and risk of death in adults with atrial fibrillation: the ATRIA-CVRN study. Circ Arrhythm Electrophysiol. 2015;8(1):49-58.
Adams KF, Patterson JH, Gattis WA, O'Connor CM, Lee CR, Schwartz TA et al. Relationship of serum digoxin concentration to mortality and morbidity in women in the digitalis investigation group trial: a retrospective analysis. J Am Coll Cardiol. 2005;46(3):497-504.
WRITING COMMITTEE MEMBERS, Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):e240-327.
Sica DA, Wood M, Hess M. Gender and its effect in cardiovascular pharmacotherapeutics: recent considerations. Congest Heart Fail. 2005;11:163-6.
Eisen A, Ruff CT, Braunwald E, Hamershock RA, Lewis BS, Hassager C et al. Digoxin Use and Subsequent Clinical Outcomes in Patients With Atrial Fibrillation With or Without Heart Failure in the ENGAGE AF-TIMI 48 Trial. J Am Heart Assoc. 2017;6(7):1.
Freedman RR, Sabharwal SC, Desai N. Sex differences in peripheral vascular adrenergic receptors. Circ Res. 1987;61:581-5.
Rejnmark L, Vestergaard P, Mosekilde L. Fracture risk in patients treated with amiodarone or digoxin for cardiac arrhythmias: a nation-wide case-control study. Osteoporos Int. 2007;18:409-17.
Koski K, Luukinen H, Laippala P, Kivela SL. Physiological factors and medications as predictors of injurious falls by elderly people: a prospective population-based study. Age Ageing. 1996;25:29-38.
Aarnoudse AL, Dieleman JP, Stricker BH. Age- and gender-specific incidence of hospitalisation for digoxin intoxication. Drug Saf. 2007;30:431-6.
Riesgo A, Sant E, Benito L, Hoyo J, Miró O, Mont L et al. Sex differences in the treatment of patients with atrial fibrillation: population-based study in a local health district. Rev Esp Cardiol. 2011;64:233-6.
Shehab A, Zubaid M, Bhagavathula AS, Rashed WA, Alsheikh-Ali AA, AlMahmeed W et al. Sex differences in management and outcomes of patients with atrial fibrillation in the Middle East: Gulf survey of atrial fibrillation events (Gulf SAFE). PLoS One. 2017;12(5):e0175405.
Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2017 [cited 2019-01-30.]
- Yukawa E, Honda T, Ohdo S, Higuchi S, Aoyama T. Population-based investigation of relative clearance of digoxin in Japanese patients by multiple trough screen analysis: an update. J Clin Pharmacol. 1997;37:92-100.
- LANOXIN (digoxin). DailyMed [www]. US National Library of Medicine. [updated 2018-08-31, cited 2019-02-11].
- Lee LS, Chan LN. Evaluation of a sex-based difference in the pharmacokinetics of digoxin. Pharmacotherapy. 2006;26:44-50.
- Rathore SS, Wang Y, Krumholz HM. Sex-based differences in the effect of digoxin for the treatment of heart failure. N Engl J Med. 2002;347:1403-11.
- Domanski M, Fleg J, Bristow M, Knox S. The effect of gender on outcome in digitalis-treated heart failure patients. J Card Fail. 2005;11:83-6.
- Lupón J, Urrutia A, González B, Díez C, Altimir S, Albaladejo C et al. Does heart failure therapy differ according to patient sex?. Clin Cardiol. 2007;30:301-5.
- Whitbeck MG, Charnigo RJ, Khairy P, Ziada K, Bailey AL, Zegarra MM et al. Increased mortality among patients taking digoxin--analysis from the AFFIRM study. Eur Heart J. 2013;34:1481-8.
- Freeman JV, Reynolds K, Fang M, Udaltsova N, Steimle A, Pomernacki NK et al. Digoxin and risk of death in adults with atrial fibrillation: the ATRIA-CVRN study. Circ Arrhythm Electrophysiol. 2015;8(1):49-58.
- Adams KF, Patterson JH, Gattis WA, O'Connor CM, Lee CR, Schwartz TA et al. Relationship of serum digoxin concentration to mortality and morbidity in women in the digitalis investigation group trial: a retrospective analysis. J Am Coll Cardiol. 2005;46(3):497-504.
- WRITING COMMITTEE MEMBERS, Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):e240-327.
- Sica DA, Wood M, Hess M. Gender and its effect in cardiovascular pharmacotherapeutics: recent considerations. Congest Heart Fail. 2005;11:163-6.
- Eisen A, Ruff CT, Braunwald E, Hamershock RA, Lewis BS, Hassager C et al. Digoxin Use and Subsequent Clinical Outcomes in Patients With Atrial Fibrillation With or Without Heart Failure in the ENGAGE AF-TIMI 48 Trial. J Am Heart Assoc. 2017;6(7):1.
- Freedman RR, Sabharwal SC, Desai N. Sex differences in peripheral vascular adrenergic receptors. Circ Res. 1987;61:581-5.
- Rejnmark L, Vestergaard P, Mosekilde L. Fracture risk in patients treated with amiodarone or digoxin for cardiac arrhythmias: a nation-wide case-control study. Osteoporos Int. 2007;18:409-17.
- Koski K, Luukinen H, Laippala P, Kivela SL. Physiological factors and medications as predictors of injurious falls by elderly people: a prospective population-based study. Age Ageing. 1996;25:29-38.
- Aarnoudse AL, Dieleman JP, Stricker BH. Age- and gender-specific incidence of hospitalisation for digoxin intoxication. Drug Saf. 2007;30:431-6.
- Riesgo A, Sant E, Benito L, Hoyo J, Miró O, Mont L et al. Sex differences in the treatment of patients with atrial fibrillation: population-based study in a local health district. Rev Esp Cardiol. 2011;64:233-6.
- Shehab A, Zubaid M, Bhagavathula AS, Rashed WA, Alsheikh-Ali AA, AlMahmeed W et al. Sex differences in management and outcomes of patients with atrial fibrillation in the Middle East: Gulf survey of atrial fibrillation events (Gulf SAFE). PLoS One. 2017;12(5):e0175405.
- Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2017 [cited 2019-01-30.]
Uppdaterat
Litteratursökningsdatum: 2/11/2019
Litteratursökningsdatum: 2/11/2019Fasstexter
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