The Experts below are selected from a list of 306 Experts worldwide ranked by ideXlab platform
Agnes L.f. Chan - One of the best experts on this subject based on the ideXlab platform.
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exposure to sennoside Digoxin interaction and risk of Digoxin Toxicity a population based nested case control study
European Journal of Heart Failure, 2011Co-Authors: Meng-ting Wang, Wan Ju Lee, Hsin-bang Leu, Tienyu Huang, Agnes L.f. ChanAbstract:Aims Digoxin is an important medication for heart failure (HF) patients and sennosides are widely used to treat constipation. Recently, safety concerns have been raised about a possible interaction between sennosides and Digoxin, an issue that has not been studied empirically. This study therefore aimed to evaluate whether exposure to sennoside–Digoxin interaction is associated with an increased risk of Digoxin Toxicity. Methods and results This was a population-based nested case–control study that analysed data obtained from the Taiwan National Health Insurance Research Database between 1 January 2001 and 31 December 2004. All HF patients treated with Digoxin for the first time were included as the study cohort. Of these, cases were identified as subjects hospitalized for Digoxin Toxicity (International Classification of Diseases, Ninth Revision, Clinical Modification, ICD-9-CM 972.1), and matched to randomly selected controls. Use of sennosides was compared between the two groups. Odds ratios (ORs) were employed to quantify the risk associated with exposure to sennoside–Digoxin interaction by conditional logistic regression. The study cohort comprised 222 527 HF patients, of whom 524 were identified as cases and 2 502 as matched controls. Use of sennosides during the 14 days preceding the index date was found to be associated with a 1.61-fold increased risk of Digoxin Toxicity [95% confidence interval (CI) = 1.15, 2.25]. Additionally, a greater risk was observed for sennosides prescribed at an average daily dose ≥24 mg (adjusted OR = 1.93; 95% CI = 1.27, 2.94). Conclusion The combined use of sennosides and Digoxin was found to be associated with a modest increased risk of Digoxin Toxicity in HF patients.
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Exposure to sennoside–Digoxin interaction and risk of Digoxin Toxicity: a population-based nested case–control study†
European journal of heart failure, 2011Co-Authors: Meng-ting Wang, Wan Ju Lee, Tien‐yu Huang, Hsin-bang Leu, Agnes L.f. ChanAbstract:Digoxin is an important medication for heart failure (HF) patients and sennosides are widely used to treat constipation. Recently, safety concerns have been raised about a possible interaction between sennosides and Digoxin, an issue that has not been studied empirically. This study therefore aimed to evaluate whether exposure to sennoside-Digoxin interaction is associated with an increased risk of Digoxin Toxicity. This was a population-based nested case-control study that analysed data obtained from the Taiwan National Health Insurance Research Database between 1 January 2001 and 31 December 2004. All HF patients treated with Digoxin for the first time were included as the study cohort. Of these, cases were identified as subjects hospitalized for Digoxin Toxicity (International Classification of Diseases, Ninth Revision, Clinical Modification, ICD-9-CM 972.1), and matched to randomly selected controls. Use of sennosides was compared between the two groups. Odds ratios (ORs) were employed to quantify the risk associated with exposure to sennoside-Digoxin interaction by conditional logistic regression. The study cohort comprised 222,527 HF patients, of whom 524 were identified as cases and 2,502 as matched controls. Use of sennosides during the 14 days preceding the index date was found to be associated with a 1.61-fold increased risk of Digoxin Toxicity [95% confidence interval (CI) = 1.15, 2.25]. Additionally, a greater risk was observed for sennosides prescribed at an average daily dose ≥ 24 mg (adjusted OR = 1.93; 95% CI = 1.27, 2.94). The combined use of sennosides and Digoxin was found to be associated with a modest increased risk of Digoxin Toxicity in HF patients.
Daniel J. G. Thirion - One of the best experts on this subject based on the ideXlab platform.
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telithromycin induced Digoxin Toxicity and electrocardiographic changes
Pharmacotherapy, 2006Co-Authors: Laura M. Nenciu, Patrice Laberge, Daniel J. G. ThirionAbstract:A 58-year-old woman who had been taking Digoxin 0.25 mg/day for more than 35 years for heart palpitations after mitral valve repair was prescribed a 5-day course of telithromycin for acute bronchitis. On the sixth day of therapy, she came to the emergency department complaining of general malaise and having experienced three episodes of syncope over the previous 2 days. Laboratory analysis revealed elevated Digoxin plasma levels, and electrocardiography showed several nonspecific repolarization anomalies. Telithromycin is known to increase Digoxin plasma levels; however, the clinical significance of this interaction is not known. To our knowledge, this is the first report of elevated plasma Digoxin levels associated with signs and symptoms of Toxicity. This drug interaction-determined as probable according to the Naranjo adverse drug reaction probability scale-may be mediated by P-glycoprotein. By inhibiting the transport of Digoxin by P-glycoprotein, telithromycin may have decreased Digoxin elimination in the intestinal lumen and its renal tubular excretion, resulting in elevated plasma levels and drug Toxicity. Clinicians should be aware of possible Digoxin Toxicity after concomitant administration with telithromycin, especially in patients who are at risk, such as those with electrolyte abnormalities and decreased renal function.
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Telithromycin‐Induced Digoxin Toxicity and Electrocardiographic Changes
Pharmacotherapy, 2006Co-Authors: Laura M. Nenciu, Patrice Laberge, Daniel J. G. ThirionAbstract:A 58-year-old woman who had been taking Digoxin 0.25 mg/day for more than 35 years for heart palpitations after mitral valve repair was prescribed a 5-day course of telithromycin for acute bronchitis. On the sixth day of therapy, she came to the emergency department complaining of general malaise and having experienced three episodes of syncope over the previous 2 days. Laboratory analysis revealed elevated Digoxin plasma levels, and electrocardiography showed several nonspecific repolarization anomalies. Telithromycin is known to increase Digoxin plasma levels; however, the clinical significance of this interaction is not known. To our knowledge, this is the first report of elevated plasma Digoxin levels associated with signs and symptoms of Toxicity. This drug interaction-determined as probable according to the Naranjo adverse drug reaction probability scale-may be mediated by P-glycoprotein. By inhibiting the transport of Digoxin by P-glycoprotein, telithromycin may have decreased Digoxin elimination in the intestinal lumen and its renal tubular excretion, resulting in elevated plasma levels and drug Toxicity. Clinicians should be aware of possible Digoxin Toxicity after concomitant administration with telithromycin, especially in patients who are at risk, such as those with electrolyte abnormalities and decreased renal function.
Meng-ting Wang - One of the best experts on this subject based on the ideXlab platform.
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exposure to sennoside Digoxin interaction and risk of Digoxin Toxicity a population based nested case control study
European Journal of Heart Failure, 2011Co-Authors: Meng-ting Wang, Wan Ju Lee, Hsin-bang Leu, Tienyu Huang, Agnes L.f. ChanAbstract:Aims Digoxin is an important medication for heart failure (HF) patients and sennosides are widely used to treat constipation. Recently, safety concerns have been raised about a possible interaction between sennosides and Digoxin, an issue that has not been studied empirically. This study therefore aimed to evaluate whether exposure to sennoside–Digoxin interaction is associated with an increased risk of Digoxin Toxicity. Methods and results This was a population-based nested case–control study that analysed data obtained from the Taiwan National Health Insurance Research Database between 1 January 2001 and 31 December 2004. All HF patients treated with Digoxin for the first time were included as the study cohort. Of these, cases were identified as subjects hospitalized for Digoxin Toxicity (International Classification of Diseases, Ninth Revision, Clinical Modification, ICD-9-CM 972.1), and matched to randomly selected controls. Use of sennosides was compared between the two groups. Odds ratios (ORs) were employed to quantify the risk associated with exposure to sennoside–Digoxin interaction by conditional logistic regression. The study cohort comprised 222 527 HF patients, of whom 524 were identified as cases and 2 502 as matched controls. Use of sennosides during the 14 days preceding the index date was found to be associated with a 1.61-fold increased risk of Digoxin Toxicity [95% confidence interval (CI) = 1.15, 2.25]. Additionally, a greater risk was observed for sennosides prescribed at an average daily dose ≥24 mg (adjusted OR = 1.93; 95% CI = 1.27, 2.94). Conclusion The combined use of sennosides and Digoxin was found to be associated with a modest increased risk of Digoxin Toxicity in HF patients.
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Exposure to sennoside–Digoxin interaction and risk of Digoxin Toxicity: a population-based nested case–control study†
European journal of heart failure, 2011Co-Authors: Meng-ting Wang, Wan Ju Lee, Tien‐yu Huang, Hsin-bang Leu, Agnes L.f. ChanAbstract:Digoxin is an important medication for heart failure (HF) patients and sennosides are widely used to treat constipation. Recently, safety concerns have been raised about a possible interaction between sennosides and Digoxin, an issue that has not been studied empirically. This study therefore aimed to evaluate whether exposure to sennoside-Digoxin interaction is associated with an increased risk of Digoxin Toxicity. This was a population-based nested case-control study that analysed data obtained from the Taiwan National Health Insurance Research Database between 1 January 2001 and 31 December 2004. All HF patients treated with Digoxin for the first time were included as the study cohort. Of these, cases were identified as subjects hospitalized for Digoxin Toxicity (International Classification of Diseases, Ninth Revision, Clinical Modification, ICD-9-CM 972.1), and matched to randomly selected controls. Use of sennosides was compared between the two groups. Odds ratios (ORs) were employed to quantify the risk associated with exposure to sennoside-Digoxin interaction by conditional logistic regression. The study cohort comprised 222,527 HF patients, of whom 524 were identified as cases and 2,502 as matched controls. Use of sennosides during the 14 days preceding the index date was found to be associated with a 1.61-fold increased risk of Digoxin Toxicity [95% confidence interval (CI) = 1.15, 2.25]. Additionally, a greater risk was observed for sennosides prescribed at an average daily dose ≥ 24 mg (adjusted OR = 1.93; 95% CI = 1.27, 2.94). The combined use of sennosides and Digoxin was found to be associated with a modest increased risk of Digoxin Toxicity in HF patients.
Robert S. Hoffman - One of the best experts on this subject based on the ideXlab platform.
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Prognostic Utility of Serum Potassium in Chronic Digoxin Toxicity
American Journal of Cardiovascular Drugs, 2011Co-Authors: Alex F. Manini, Lewis S. Nelson, Robert S. HoffmanAbstract:Objective In contrast to patients with acute Digoxin overdose, the prognostic utility of the serum potassium concentration for patients with chronic Digoxin Toxicity is unclear. In such patients, we aimed to evaluate the relationship between pre-treatment serum potassium and survival. Methods This was a case-control study at an urban Poison Control Center affiliated with a large urban medical center. We compared the serum potassium concentration between patients with chronic Digoxin Toxicity resulting in fatality (cases) over a 7-year period (2000–2006) versus survivors (controls) over a 1-year period (2007–2008). Results During the study period, there were 13 fatalities (cases) and 13 survivors (controls), of whom seven cases and five controls received appropriately dosed Digoxin-specific antibody Fab fragments (Fab). There were no statistically significant differences between cases and controls with respect to serum Digoxin concentration, creatinine, age, or sex. Serum potassium elevation pre-Fab was significantly associated with fatality both in mean difference (p
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Prognostic utility of serum potassium in chronic Digoxin Toxicity: a case-control study.
American journal of cardiovascular drugs : drugs devices and other interventions, 2011Co-Authors: Alex F. Manini, Lewis S. Nelson, Robert S. HoffmanAbstract:In contrast to patients with acute Digoxin overdose, the prognostic utility of the serum potassium concentration for patients with chronic Digoxin Toxicity is unclear. In such patients, we aimed to evaluate the relationship between pre-treatment serum potassium and survival. This was a case-control study at an urban Poison Control Center affiliated with a large urban medical center. We compared the serum potassium concentration between patients with chronic Digoxin Toxicity resulting in fatality (cases) over a 7-year period (2000-2006) versus survivors (controls) over a 1-year period (2007-2008). During the study period, there were 13 fatalities (cases) and 13 survivors (controls), of whom seven cases and five controls received appropriately dosed Digoxin-specific antibody Fab fragments (Fab). There were no statistically significant differences between cases and controls with respect to serum Digoxin concentration, creatinine, age, or sex. Serum potassium elevation pre-Fab was significantly associated with fatality both in mean difference (p < 0.03) and using a dichotomous cutoff of 5.0 mEq/L (p < 0.001), which performed with 92% sensitivity (95% CI 67, 99). In 86% of deaths despite appropriate Fab administration, the clinical presentation included the combination of bradycardia plus hyperkalemia. In these patients with chronic Digoxin Toxicity, elevated serum potassium was associated with fatality. The combination of bradycardia and hyperkalemia strongly predicted fatality even in cases with appropriate Fab administration.
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prognostic utility of serum potassium in chronic Digoxin Toxicity a case control study
American Journal of Cardiovascular Drugs, 2011Co-Authors: Alex F. Manini, Lewis S. Nelson, Robert S. HoffmanAbstract:Objective In contrast to patients with acute Digoxin overdose, the prognostic utility of the serum potassium concentration for patients with chronic Digoxin Toxicity is unclear. In such patients, we aimed to evaluate the relationship between pre-treatment serum potassium and survival.
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Inconsistent approach to the treatment of chronic Digoxin Toxicity in the United States
Human & experimental toxicology, 2009Co-Authors: Barbara M. Kirrane, Lewis S. Nelson, Ruben Olmedo, Maria Mercurio-zappala, M. A. Howland, Robert S. HoffmanAbstract:Evidence-based guidelines do not exist for the treatment of patients with chronic mild-moderate Digoxin Toxicity. We sought to evaluate differences among specialists in the use of Digoxin-specific antibody fragments and the decision to admit these patients. A sample of cardiologists, emergency physicians, and medical toxicologists was surveyed. The survey detailed four hypothetical cases of chronic Digoxin Toxicity created by consensus among authors. All cases had the same Digoxin concentration, but signs and symptoms varied in an attempt to explore four different thresholds. For each scenario, clinicians made decisions about admission and treatment. Survey response varied: cardiologists 17%, emergency physicians 6.7%, and toxicologists 39%. Statistically significant difference was found in the administration of Fab among cardiologists (67%), emergency physicians (82%), or toxicologists (91.5%) and admission rate (cardiologists 34%, emergency physicians 28%, and toxicologists 46%). Differences exist among clinicians of various specialties regarding treatment of chronic Digoxin Toxicity. These differences may reflect diverse perspectives or knowledge gaps and may translate into excess cost or less than ideal care. Exploring these differences may improve patient care, improve interactions among providers, and set the stage for development of consensus guidelines and research.
Laura M. Nenciu - One of the best experts on this subject based on the ideXlab platform.
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telithromycin induced Digoxin Toxicity and electrocardiographic changes
Pharmacotherapy, 2006Co-Authors: Laura M. Nenciu, Patrice Laberge, Daniel J. G. ThirionAbstract:A 58-year-old woman who had been taking Digoxin 0.25 mg/day for more than 35 years for heart palpitations after mitral valve repair was prescribed a 5-day course of telithromycin for acute bronchitis. On the sixth day of therapy, she came to the emergency department complaining of general malaise and having experienced three episodes of syncope over the previous 2 days. Laboratory analysis revealed elevated Digoxin plasma levels, and electrocardiography showed several nonspecific repolarization anomalies. Telithromycin is known to increase Digoxin plasma levels; however, the clinical significance of this interaction is not known. To our knowledge, this is the first report of elevated plasma Digoxin levels associated with signs and symptoms of Toxicity. This drug interaction-determined as probable according to the Naranjo adverse drug reaction probability scale-may be mediated by P-glycoprotein. By inhibiting the transport of Digoxin by P-glycoprotein, telithromycin may have decreased Digoxin elimination in the intestinal lumen and its renal tubular excretion, resulting in elevated plasma levels and drug Toxicity. Clinicians should be aware of possible Digoxin Toxicity after concomitant administration with telithromycin, especially in patients who are at risk, such as those with electrolyte abnormalities and decreased renal function.
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Telithromycin‐Induced Digoxin Toxicity and Electrocardiographic Changes
Pharmacotherapy, 2006Co-Authors: Laura M. Nenciu, Patrice Laberge, Daniel J. G. ThirionAbstract:A 58-year-old woman who had been taking Digoxin 0.25 mg/day for more than 35 years for heart palpitations after mitral valve repair was prescribed a 5-day course of telithromycin for acute bronchitis. On the sixth day of therapy, she came to the emergency department complaining of general malaise and having experienced three episodes of syncope over the previous 2 days. Laboratory analysis revealed elevated Digoxin plasma levels, and electrocardiography showed several nonspecific repolarization anomalies. Telithromycin is known to increase Digoxin plasma levels; however, the clinical significance of this interaction is not known. To our knowledge, this is the first report of elevated plasma Digoxin levels associated with signs and symptoms of Toxicity. This drug interaction-determined as probable according to the Naranjo adverse drug reaction probability scale-may be mediated by P-glycoprotein. By inhibiting the transport of Digoxin by P-glycoprotein, telithromycin may have decreased Digoxin elimination in the intestinal lumen and its renal tubular excretion, resulting in elevated plasma levels and drug Toxicity. Clinicians should be aware of possible Digoxin Toxicity after concomitant administration with telithromycin, especially in patients who are at risk, such as those with electrolyte abnormalities and decreased renal function.