Radioimmunoassay of salivary digoxin by simple adaptation of a kit method for serum digoxin: saliva/serum ratio and correlation.

A robust commercial radioimmunoassay kit for serum digoxin was adapted to salivary assay by simple procedural modifications and shown to have satisfactory sensitivity, precision, accuracy, and specificity. The digoxin saliva/serum concentration ratio in 50 hospital patients was 0.67 +/- 0.10 (mean +/- SD), and the levels were well correlated (r = 0.96). Similar saliva/serum ratios were found in two normal subjects who took digoxin orally, and the free fraction in serum, determined by equilibrium dialysis, was found to equate with the salivary drug level. Digoxin appeared in saliva at its maximum level within 1 min of intravenous injection. Although previous studies of salivary digoxin have given widely discrepant results, the present findings are entirely consistent with the simple expectation that digoxin should appear in saliva by passive diffusion. Salivary sampling is suitable for the monitoring of digoxin therapy and pharmacokinetics, and the modified radioimmunoassay should be of value to laboratories wishing to introduce this technique.