The Effect of Penicillamine on Serum Digoxin Levels

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The effect of 1Gm of penicillamine (pen) on serum digoxin levels (SDLs) of 3 groups of patients (Pts) on maintenance digoxin therapy was studied. Each group served as its own control. Group I (10pts) had serum digoxin measurements (SDMs) 2, 4, and 6 hours (hrs) after receiving their daily oral doses of digoxin. The next day SDMs were made similarly following 1Gm of pen 2hrs after administration of digoxin. In all pts the SDLs were significantly lower 2, 4, and 6hrs after receiving pen (1.86±0.25 VS 1.62±0.22, 1.80±0.17 VS 1.44±0.26, 1.87±0.27 VS 1.14±0.24ng/ml, mean±SD with respective p values<0.025, <0.005 and <0.001).In order to exclude the interference of pen on digoxin absorption, Group II (13pts) had SDMs 22hrs after their last oral doses of digoxin before and 6hrs after receiving 1Gm of pen. In this group SDLs were also significantly reduced (1.50±0.48 VS 1.16±0.51ng⁄ml, mean±SD, <0.05).Group III (10pts) received maintenance intravenous digoxin for 5 days prior to SDM. In this group also marked reduction of SDM was observed 4 and 6hrs following 1Gm of pen (1.36±0.50 VS 1.04±0.40, 1.46±0.69 VS 0.50±0.64ng⁄ml, mean±SD with p values of <0.001 and <0.005, respectively). It can be concluded that oral penicillamine reduces SDL significantly in digitalized pts irrespective of the route of digoxin administration and may be of significant value in management of digitalis toxicity.
International Heart Journal刊行会の論文