Monitorización de digoxina en pacientes con insuficiencia cardiaca congestiva del Hospital Regional Vicente Corral Moscoso por métodos Bayesianos

Abstract

Congestive heart failure is a problem associated with a decrease in the functioning of the heart's ionotropism. To control this pathological process, cardiotonic drugs such as digitalis are required, which present a narrow therapeutic margin, which makes the therapeutic management of affected patient’s complex. Therefore, the objective of the present study was to monitor digoxinemia and optimize its dose in patients with congestive heart failure at Hospital Vicente Corral Moscoso by Bayesian methods.

This investigation was carried out in 39 patients who were determined plasma levels of digoxin by enzyme immunoassay. Based on these results, the pharmacokinetic and bayesian simulation parameters were estimated to perform the dose adjustment using the PKS ABBOTTBASE software shared by the Pharmaceutical Technology Department of the University of Salamanca, Spain. The results obtained from the plasma concentrations determined that 46.15% patients were underdosed, 43.59% in therapeutic window, and 10.26% in toxic range. Of the latter subjects, two were women and two were men, both of whom were elderly with clearance <60 ml / min / 1.72m2. Regarding polypharmacy, 3 patients were taking digoxin plus spironolactone and 1 patient received combined treatment with digoxin plus spironolactone and verapamil, factors that influenced the increase in digoxinemia. The dose adjustment using the Bayesian model was performed in 38 patients (97.44%) and without adjustment to 1 patient (2.56%). Of the subjects with adjustment it was necessary to review the dose and interval to 30 patients (76, 92%), 7 patients only their dose (17, 95%), 1 patient adjusted the interval (2, 36%) and only 1 patient was not modified (2, 36 %).