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Clinical Chemistry 44: 1096-1109, 1998;
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(Clinical Chemistry. 1998;44:1096-1109.)
© 1998 American Association for Clinical Chemistry, Inc.

NACB Symposium

Standards of laboratory practice: cardiac drug monitoring

Roland Valdes, Jr.1,a, Saeed A. Jortani1, and Mihai Gheorghiade2

1 Department of Pathology and Laboratory Medicine, University of Louisville, KY 40292.

2 Division of Cardiology, Northwestern University Medical School, Chicago, IL 60611.
a Author for correspondence. Fax 502-852-1771; e-mail r0vald01{at}homer.louisville.edu.

In this Standard of Laboratory Practice we recommend guidelines for therapeutic monitoring of cardiac drugs. Cardiac drugs are primarily used for treatment of angina, arrhythmias, and congestive heart failure. Digoxin, used in congestive heart failure, is widely prescribed and therapeutically monitored. Monitoring and use of antiarrhythmics such as disopyramide and lidocaine have been steadily declining. Immunoassay techniques are currently the most popular methods for measuring cardiac drugs. Several reasons make measurement of cardiac drugs in serum important: their narrow therapeutic index, similarity in clinical complications and presentation of under- and overmedicated patients, need for dosage adjustments, and confirmation of patient compliance. Monitoring may also be necessary in other circumstances, such as assessment of acetylator phenotypes. We present recommendations for measuring digoxin, quinidine, procainamide (and N-acetylprocainamide), lidocaine, and flecainide. We discuss guidelines for measuring unbound digoxin in the presence of an antidote (Fab fragments), for characterizing the impact of digoxin-like immunoreactive factor (DLIF) and other cross-reactants on immunoassays, and for monitoring the unbound (free fraction) of drugs that bind to {alpha}1-acid glycoprotein. We also discuss logistic, clinical, hospital, and laboratory practice guidelines needed for implementation of a successful therapeutic drug monitoring service for cardiac drugs.




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M. Gheorghiade, K. F. Adams Jr, and W. S. Colucci
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W. Steimer, C. Muller, and B. Eber
Digoxin Assays: Frequent, Substantial, and Potentially Dangerous Interference by Spironolactone, Canrenone, and Other Steroids
Clin. Chem., March 1, 2002; 48(3): 507 - 516.
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P. Rainey, I. T. Ocal, and T. R. Green
Digibind and Free Digoxin • The authors of the article cited above respond:
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R. Valdes Jr. and S. A. Jortani
Monitoring of Unbound Digoxin in Patients Treated with Anti-Digoxin Antigen-binding Fragments: A Model for the Future?
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