Renal Tubular Secretion of Digoxin

Abstract

To study the mechanism of the renal handling of digoxin, simultaneous measurements of digoxin and inulin clearances were performed in 13 digitalized patients with congestive heart disease. The renal digoxin clearances exceeded inulin clearances, indicating an active tubular secretion of digoxin. No evidence of tubular backward diffusion was disclosed. Treatment with spironolactone (Aldactone) decreased the digoxin clearances, suggesting an inhibition of the tubular secretion of digoxin in the distal segment of the renal tubulus. After blocking the tubular secretion, the calculated renal clearances of nonproteinbound digoxin in plasma were similar to that of inulin, suggesting a glomerular filtration of free plasma digoxin. Plasma digoxin level rose during treatment with spironolactone.