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Clinical Chemistry 42: 45-49, 1996;
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Clinical Chemistry, Vol 42, 45-49, Copyright © 1996 by American Association for Clinical Chemistry

Nighttime dosing assures postdistribution sampling for therapeutic drug monitoring of digoxin

DW Bernard, RL Bowman, FA Grimm, BA Wolf, MB Simson and LM Shaw
Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.

To study the appropriateness of phlebotomy for digoxin therapeutic drug monitoring (TDM) in outpatients, we conducted a retrospective chart review, a computer search of all previous TDM testing, and a questionnaire of all outpatients (n = 86) who had serum digoxin determinations between April 10 and April 28, 1992 (585 tests). In patients who took digoxin at the same time daily (40 patients, 300 tests), 52% of tests were performed on inappropriate samples drawn within 6 h of the last dose. No patient who took digoxin after 1700 had inappropriate tests. Phlebotomy for serum digoxin determinations before distribution of digoxin is complete is a common problem in outpatients, leading to clinically uninterpretable test results. Postdistribution sampling can be assured by nighttime dosing, and this recommendation has been implemented at our hospital.


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