From the Research
Digoxin's function is significantly altered during hypothermia, requiring careful monitoring and potential dose adjustments. During hypothermic conditions, digoxin's pharmacokinetics and pharmacodynamics change substantially, leading to higher serum concentrations and increased risk of toxicity at standard dosing 1. The most recent and highest quality study on digoxin levels and toxicity, published in 2016, found that serum digoxin concentrations are not strongly associated with signs and symptoms of digoxin toxicity in children 1. However, this study does not directly address the context of hypothermia. Considering the principles of pharmacology and the effects of hypothermia on drug metabolism and cardiac electrophysiology, clinicians should consider reducing digoxin doses by approximately 25-50% during therapeutic hypothermia or in hypothermic patients, while monitoring serum levels more frequently. Some key points to consider in the management of digoxin during hypothermia include:
- Monitoring for signs and symptoms of digoxin toxicity, such as nausea, vomiting, and cardiac arrhythmias
- Maintaining serum potassium levels within a normal range to minimize the risk of digoxin toxicity
- Adjusting digoxin dosing as needed to maintain therapeutic levels during hypothermia and rewarming
- Close cardiac monitoring for potential exacerbation of bradycardia and atrioventricular blocks. It is essential to prioritize careful monitoring and potential dose adjustments to minimize the risk of digoxin toxicity during hypothermia, as the combination of digoxin and hypothermia can have significant effects on cardiac electrophysiology 2.