Digitalis Toxicity and Serum Levels

PEDIATRICS ◽  
1979 ◽  
Vol 63 (3) ◽  
pp. 503-504
Author(s):  
William Berman
Keyword(s):  
Serum Level ◽  
Maintenance Dose ◽  
Magic Number ◽  
Serum Levels ◽  
Drug Clearance ◽  
Drug Dose ◽  
Infants And Children ◽  
Digitalis Toxicity ◽  
Lack Of Information ◽  
In Infants And Children

The article by Halkin et al (Pediatrics 61: 184, February 1978) alerts pediatricians to the prevalence of toxicity to dligoxin in infants and children. However, I am concerned that casual reading of the article will lead some to conclude that tolerance to digoxin does not vary with age and that a serum level of digoxin of 2 ng/ml is a "magic number." Neither of these conclusions is substantiated by the data in the manuscript. The findings of the series are clouded somewhat by the broad criteria used for diagnosing toxicity, the time at which serum specimens were obtained (eight hours after the preceding maintenance dose), and the lack of information about drug clearance as it relates to drug dose and the serum levels achieved.

scholarly journals Developmental Pharmacokinetics in Pediatric Populations

2014 ◽  
Vol 19 (4) ◽  
pp. 262-276 ◽  
Author(s):  
Hong Lu ◽  
Sara Rosenbaum
Keyword(s):  
Drug Absorption ◽  
Pediatric Population ◽  
Drug Distribution ◽  
Drug Dose ◽  
Tubular Secretion ◽  
Infants And Children ◽  
Water Composition ◽  
Age Related ◽  
The Impact ◽  
In Infants And Children

Information on drug absorption and disposition in infants and children has increased considerably over the past 2 decades. However, the impact of specific age-related effects on pharmacokinetics, pharmacodynamics, and dose requirements remains poorly understood. Absorption can be affected by the differences in gastric pH and stomach emptying time that have been observed in the pediatric population. Low plasma protein concentrations and a higher body water composition can change drug distribution. Metabolic processes are often immature at birth, which can lead to a reduced clearance and a prolonged half-life for those drugs for which metabolism is a significant mechanism for elimination. Renal excretion is also reduced in neonates due to immature glomerular filtration, tubular secretion, and reabsorption. Limited data are available on the pharmacodynamic behavior of drugs in the pediatric population. Understanding these age effects provide a mechanistic way to identify initial doses for the pediatric population. The various factors that impact pharmacokinetics and pharmacodynamics mature towards adult values at different rates, thus requiring continual modification of drug dose regimens in neonates, infants, and children. In this paper, the age-related changes in drug absorption, distribution, metabolism, and elimination in infants and children are reviewed, and the age-related dosing regimens for this population are discussed.

Digoxin intoxication in infants and children: Correlation with serum levels

1974 ◽  
Vol 84 (2) ◽  
pp. 265-269 ◽  
Author(s):  
William L. Nyhan ◽  
Harry C. Shirkey ◽  
Richard Krasula ◽  
Ruth Yanagi ◽  
Alois R. Hastreiter ◽  
...  
Keyword(s):  
Serum Levels ◽  
Infants And Children ◽  
Digoxin Intoxication ◽  
In Infants And Children

Serum levels of digoxin in infants and children

1972 ◽  
Vol 81 (3) ◽  
pp. 566-569 ◽  
Author(s):  
Richard W. Krasula ◽  
Piero A. Pellegrino ◽  
Alois R. Hastreiter ◽  
Lester F. Soyka
Keyword(s):  
Serum Levels ◽  
Infants And Children ◽  
In Infants And Children

Digitalis toxicity in infants and children

1984 ◽  
Vol 5 (2) ◽  
pp. 131-148 ◽  
Author(s):  
Alois R. Hastreiter ◽  
Ronald L. van der Horst ◽  
Elizabeth Chow-Tung
Keyword(s):  
Infants And Children ◽  
Digitalis Toxicity ◽  
In Infants And Children

DIGOXIN DOSAGE IN INFANTS

PEDIATRICS ◽  
1956 ◽  
Vol 18 (5) ◽  
pp. 730-738
Author(s):  
Samuel O. Sapin ◽  
Ephraim Donoso ◽  
Sidney Blumenthal
Keyword(s):  
Maintenance Dose ◽  
Clinical Effect ◽  
Digitalis Toxicity ◽  
Once Daily ◽  
Titration Experiment ◽  
T Wave ◽  
Drug Of Choice ◽  
Digitalis Therapy ◽  
Maximum Benefit ◽  
In Infants And Children

Digoxin is suggested as the drug of choice for digitalis therapy in infants and children, primarily because of its rapid dissipation. The use of average dosage figures, while necessary in starting therapy, is often unsatisfactory and may be hazardous unless one appreciates the great range of sensitivity to digitalis amongst patients. The principle set forth by Withering and repeated by many since then that each patient treated with digitalis is a titration experiment, still holds. Our studies and experience with digoxin in normal infants as well as in those with heart disease enable us to propose a digitalizing regimen which has proven effective and yet safe in most of the infants who can benefit from digitalis therapy. We recommend an initial "digitalizing dose" of 75 µg/kg in 24 hours, orally or intramuscularly. One-half or one-third is given first and the remainder in equal portions every 6 to 8 hours. If the desired clinical effect is evident, a maintenance dose of 25 µg/kg once daily is administered. If, however, the desired clinical effect has not been achieved after the initial "digitalizing dose," 25 µg/kg should be given under careful clinical and electrocardiographic observation every 6, 8 or 12 hours (depending upon the severity of the failure) until either a satisfactory effect or toxic signs appear. The maintenance dose may then be proportionately larger. Changes in S-T segment and T wave in the electrocardiogram are not considered signs of toxicity. The development of vomiting or the appearance in the electrocardiogram of significant conduction defects, or arrhythmias are indications of digitalis toxicity. Relatively large amounts of digoxin may be necessary in some infants both initially and for maintenance in order to obtain maximum benefit from the drug.

Serum Levels of Hepatitis C Virus RNA in Infants and Children with Chronic Hepatitis C

1999 ◽  
Vol 29 (3) ◽  
pp. 314-317 ◽  
Author(s):  
Chiara Azzari ◽  
Massimo Resti ◽  
Flavia Bortolotti ◽  
Maria Moriondo ◽  
Carlo Crivellaro ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Serum Levels ◽  
Infants And Children ◽  
Hepatitis C Virus Rna ◽  
Virus Rna ◽  
In Infants And Children

scholarly journals Clinical pharmacology of teicoplanin in infants and children

2021 ◽  
Vol 3 (6) ◽  
pp. 01-07
Author(s):  
Gian Pacific
Keyword(s):  
Cell Wall ◽  
Maintenance Dose ◽  
Molecular Size ◽  
The Body ◽  
Infants And Children ◽  
Published Data ◽  
Loading Dose ◽  
Older Children ◽  
Once Daily ◽  
In Infants And Children

Teicoplanin is a glycopeptide and is a mixture of related glycopeptides. Teicoplanin inhibits the synthesis of the cell wall in sensitive bacteria by binding with high affinity to the D-alanyl-D-alanine terminus of cell wall precursor units. Because of its large molecular size, teicoplanin is unable to penetrate the outer membrane of gram-negative bacteria. The intravenous dosage of teicoplanin consists in a loading dose of 16 mg/kg followed by a maintenance dose of 8 mg/kg once-daily to infants aged < one month and in older infants the dosage of teicoplanin consists in a loading dose of 12 mg/kg twice-daily followed by a maintenance dose of 10 mg/kg once daily. In children, the oral dose is 100 to 200 mg twice-daily and the intravenous dosage consists in 12 mg/kg twice-daily followed by 12 mg/kg once-daily. Teicoplanin has been found efficacy and safe in infants and children. The elimination half-life of teicoplanin is 73.9 hours in infants and children and teicoplanin is cleared from the body by renal and extra-renal routes. The total body clearance of teicoplanin is 0.09 L/h in children aged < 12 months and 0.29 L/h in older children. The treatment and the prophylaxis with teicoplanin have been described in infants and children. Teicoplanin administered intravenously and/or intraventricularly treats the cerebral infections caused by staphylococci and enterococci. The aim of this study is to review the published data on teicoplanin dosing, efficacy and safety, pharmacokinetics, drug-interactions, treatment, prophylaxis, and penetrates into the cerebrospinal fluid in infants and children.

Sign in / Sign up

Export Citation Format

Share Document