Why take digoxin at night
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Benefits of Taking Digoxin at Night
Optimized Therapeutic Drug Monitoring (TDM)
One of the primary reasons for taking digoxin at night is to ensure accurate therapeutic drug monitoring (TDM). Research indicates that phlebotomy for serum digoxin determinations often occurs before the drug has fully distributed in the body, leading to clinically uninterpretable test results. A study found that 52% of tests were performed on inappropriate samples drawn within 6 hours of the last dose when patients took digoxin at the same time daily. However, no inappropriate tests were recorded for patients who took digoxin after 5 PM. Nighttime dosing ensures postdistribution sampling, thereby providing more accurate TDM results1.
Improved Heart Rate Control in Atrial Fibrillation
Patients with atrial fibrillation often experience significant heart rate variability with digoxin therapy. A study comparing the effects of doubling the digoxin dosage versus adding verapamil found that both treatments significantly lowered heart rate. However, high-dose digoxin caused more nighttime bradycardia. The addition of verapamil to digoxin was superior, producing better control of heart rate variability with less nighttime bradycardia. This suggests that nighttime dosing of digoxin, possibly in combination with other medications, can help manage heart rate more effectively3.
Convenience and Compliance
Administering digoxin at night is also convenient for patients, as it aligns with the timing of blood sampling the next morning. This practice allows ample time for tissue distribution, making it easier to obtain accurate serum digoxin levels. This convenience can improve patient compliance with the medication regimen, ensuring more consistent therapeutic outcomes4.
Conclusion
Taking digoxin at night offers several benefits, including more accurate therapeutic drug monitoring, better control of heart rate variability in atrial fibrillation, and improved patient compliance. These advantages make nighttime dosing a recommended practice for optimizing the therapeutic effects of digoxin.
Sources and full results
Most relevant research papers on this topic
Nighttime dosing assures postdistribution sampling for therapeutic drug monitoring of digoxin.
Nighttime dosing ensures postdistribution sampling for digoxin therapeutic drug monitoring, reducing inappropriate phlebotomy and improving clinically interpretable test results in outpatients.
Observational StudyA possible mechanism for alteration of human erectile function by digoxin: inhibition of corpus cavernosum sodium/potassium adenosine triphosphatase activity.
Digoxin alters human erectile function by inhibiting corporeal smooth muscle sodium pump activity, promoting contraction and preventing nitric oxide-induced relaxation.
RCTTowards improved control of atrial fibrillation.
Adding verapamil to digoxin significantly improves heart rate variability control and reduces nighttime bradycardia in patients with atrial fibrillation compared to increasing digoxin dose alone.
RCTDrug interaction between digoxin and bisacodyl
Bisacodyl interacts with digoxin, reducing serum digoxin concentration in volunteers, likely due to interference with absorption.
Non-RCTMORNING-EVENING ADMINISTRATION TIME DIFFERENCES IN DIGOXIN KINETICS IN HEALTHY YOUNG SUBJECTS
Digoxin pharmacokinetics show a shorter Tmax (peak plasma concentration) when administered in the morning compared to the evening, but other parameters show no time-dependent variation.
Non-RCTChronic Treatment with Fluvoxamine, Clovoxamine, and Placebo: Interaction with Digoxin and Effects on Sleep and Alertness
Fluvoxamine and clovoxamine have different effects on sleep and alertness in healthy volunteers, but neither significantly affect the kinetics of digoxin.
RCTDigoxin: Pharmacology and toxicology-A review.
Digoxin is a cardiac glycoside used for treating heart problems, but its pharmacology and toxicology require careful monitoring and appropriate therapy regimens.
HEART-RATE-VARIABILITY IN PATIENTS WITH MILD-TO-MODERATE HEART-FAILURE - EFFECTS OF NEUROHORMONAL MODULATION BY DIGOXIN AND IBOPAMINE
Digoxin may prevent progressive deterioration in heart rate variability in patients with early stages of heart failure, while ibopamine shows no significant effects.
RCTInteraction between Chinese medicine and digoxin: Clinical and research update
TCM formulations may interact with digoxin, potentially causing adverse reactions and enhancing the efficacy and safety of the drug in clinical practice.
Systematic ReviewToxication due to overdose of digoxin
Overdosing on digoxin can worsen asthma symptoms and cause toxication, requiring immediate withdrawal and symptomatic treatment.
Case Report