Thesis (M.Sc.) - Cairo University - Faculty of Pharmacy - Department of Pharmaceutics

Digoxin is a cardiac glycoside prescribed in heart failure and atrial fibrillation. It exerts positive inotropic, neurohormonal and electrophysiological actions on the heart. Because of inter and intra-patient variability, narrow therapeutic index, and risk of toxicity, digoxin doses are calculated based on the patient weight, renal status, indications and drug interactions. In Egypt most cardiologists give digoxin holiday (the drug is off for one or two days a week) for both atrial fibrillation and heart failure to avoid possible drug accumulation and toxicity. It is not clear if these interrupted digoxin regimens really offer safer alternative over the continuous dosing regimens without compromising the effectiveness and patient quality of life. It is anticipated that plasma digoxin levels may fall below the therapeutic range during the holiday which may affect patient clinical status. To evaluate and compare the digoxin serum concentration and patient{u2019}s quality of life in the continuous versus interrupted digoxin dosing regimens. Patients were randomized to receive one of four regimens: regimen 1: one tablet (0.25mg) daily except Friday (N=17); regimen 2: one tablet (0.25mg) daily except Thursday and Friday (N=17); regimen 3: half tablet (0.125mg) daily (N=17); and regimen 4: a tailored dose was calculated based on patient{u2019}s renal function and given daily (N=23). After reaching steady state in the two holiday regimens, two plasma samples were collected (preholiday and post holiday trough concentrations); in the other two groups one trough plasma sample was collected

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