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Digoxin

So Many Interferences and How to Eliminate Them

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Handbook of Drug Monitoring Methods

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Summary

Digoxin is a cardioactive drug with a narrow therapeutic range. Both endogenous and exogenous compounds interfere with the determination of digoxin in serum by using immunoassays. Endogenous compounds are termed as digoxin-like immunoreactive substances (DLIS) and elevated DLIS concentrations are encountered in volume-expanded patients such as those with uremia, essential hypertension, liver disease, and preeclampsia. DLIS cross-reacts with anti-digoxin antibodies and may falsely elevate (positive interference) or falsely lower (negative interference) serum digoxin concentrations, thus causing problems in interpreting results. Exogenous compounds that interfere with digoxin assays are various Chinese medicines such as Chan Su, Lu-Shen Wan, and oleander-containing herbal preparations. Therapy with spironolactone, canrenone, or potassium canrenoate may also interfere with digoxin immunoassays. However, endogenous DLIS as well as components of various Chinese medicines are strongly protein bound whereas digoxin is weakly protein bound (25%). Taking advantage of the differences in protein binding, interference of both endogenous DLIS and Chinese medicines in serum digoxin measurement can be mostly eliminated by monitoring digoxin concentrations in the protein-free ultrafiltrates. Monitoring free digoxin also eliminates spironolactone interference (if used in moderate dosage) in serum digoxin measurement using immunoassay.

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  1. Amitava Dasgupta PhD
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  1. Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, Houston, TX

    Amitava Dasgupta PhD,DABCC,FACB

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Dasgupta, A. (2008). Digoxin. In: Dasgupta, A. (eds) Handbook of Drug Monitoring Methods. Humana Press. https://doi.org/10.1007/978-1-59745-031-7_6

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