Loading and Maintenance Doses of Digoxin in Patients with Normal Renal Function and Those with Severely Impaired Renal Function

¹ College of Pharmacy and the Upjohn Center for Clinical Pharmacology, The University of Michigan, Ann Arbor, Mich. 48104.

Pharmacokinetic analysis indicates that patients with severely impaired renal function should receive the same loading dose of digoxin as patients with normal renal function. The calculated loading dose for both types of patients, however, is appreciably lower than the usually recommended loading doses in the literature. The analysis has indicated that the patients with severely impaired renal function should be administered maintenance doses of digoxin which are only about one half those administered to patients with normal renal function. Under these conditions, both types of patients will have equal average amounts of digoxin in the body (and in compartment 2 of the two-compartment open model) at the steady state. To achieve equal average steady state plasma concentrations, the maintenance dose of the patients with severely impaired renal function would have to be one third of the maintenance dose administered to patients with normal renal function; the loading dose would have to be about five times the maintenance dose for the severely impaired renal patients, and about two and a half times the maintenance dose for the patients with normal renal function. Thus, using the plasma concentration criterion, the loading dose in patients with severely impaired renal function would be two thirds of the loading for patients with normal renal function, since 5.0*0.33/2.5*1 = 1.65/2.50.67.

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