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Optimal Digoxin Concentrations for Patients With Heart Failure
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To the Editor: We have 2 concerns about the study of Mr Rathore and colleagues.1 First, about 70% of ingested digoxin is eliminated renally.2 Nonetheless, the small differences in glomerular filtration rate and in dosing between the 3 digoxin groups reported by Rathore et al, although statistically significant, certainly do not explain the more than 2-fold increase in SDCs between groups.
Second, P-glycoprotein has been shown to have a major role in digoxin pharmacokinetics.3 P-glycoprotein, a xenobiotic transport protein located in the intestine, liver, kidney, and other tissues, influences drug absorption and elimination.3 Drugs that inhibit the activity of P-glycoprotein have been shown to increase SDCs.3 Amiodarone, an antiarrhythmic agent commonly used in the prevention of recurrent ventricular arrhythmias in patients with heart failure,4 approximately doubles SDCs by inhibiting P-glycoprotein transport.5 Because Rathore et al did not provide data on prior on antiarrhythmic use or prior history of ventricular arrhythmias, . . . [Full Text of this Article]
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