Reduction of Digitalis Toxicity by Computer-Assisted Glycoside Dosage Regimens

Abstract

Computer-assisted dosage regimens of digitalis leaf, digitoxin, digoxin, and deslanoside (Cedilanid-D®) have reduced the frequency of adverse reactions to such glycosides from 35% to 12% (P < 0.001) in one group of patients and to 4% in another group (P < 0.05). These regimens have increased the precision and safety of digitalis therapy, especially in renal disease or in uncertain states of digitalization. The computer program employs mathematical descriptions of digitalis-glycoside kinetics in patients with normal and reduced renal function. The computed total body glycoside concentrations correlate with clinical behavior, serum glycoside levels, and myocardial digoxin levels. Computed body concentrations can be compared with the patient's past and present clinical state; a new concentration to achieve can be selected. The computer prints a dosage regimen for the stated therapeutic goals, adjusted to body weight, renal function, and route of administration, properly replacing other glycosides if present.