Bendayan R, McKenzie M W
Clin Pharm. 1983 May-Jun;2(3):224-35.
The pharmacokinetic properties and dosage guidelines for digoxin in pediatric patients with congestive heart failure are reviewed. Interindividual variability in the pharmacokinetics of digoxin in pediatric patients has been reported. The bioavailability of digoxin elixir in newborns and infants is similar to adults; however, the apparent volume of distribution has been reported to be greater in infants than in adults. The total body clearance of digoxin is lowest in premature and full-term neonates and highest in infants aged one month to one year. The elimination half-life of digoxin has been reported to vary significantly among the different age groups of pediatric patients. The usefulness of monitoring digoxin serum concentrations in pediatric patients remains a controversial issue. Serum samples should be drawn under steady-state conditions to evaluate predicted daily maintenance doses. Although infants have been reported to be more tolerant than adults to elevated serum digoxin concentrations, infants experience a higher rate of digoxin toxicity than previously realized. Recent studies have shown appropriate therapeutic response in neonates and infants when low dosages of digoxin are administered. Low digoxin dosage regimens should be used initially for infants with congestive heart failure. If the clinical response is unsatisfactory or if toxicity is suspected, steady-state serum concentrations should be determined and the dosage adjusted.
本文综述了地高辛在充血性心力衰竭儿科患者中的药代动力学特性和剂量指南。已有报道称，儿科患者地高辛药代动力学存在个体间差异。新生儿和婴儿地高辛酏剂的生物利用度与成人相似；然而，据报道婴儿的表观分布容积比成人更大。地高辛的全身清除率在早产儿和足月儿中最低，在1个月至1岁的婴儿中最高。据报道，地高辛的消除半衰期在不同年龄组的儿科患者中差异显著。监测儿科患者地高辛血清浓度的实用性仍然是一个有争议的问题。应在稳态条件下采集血清样本，以评估预测的每日维持剂量。尽管有报道称婴儿比成人更能耐受血清地高辛浓度升高，但婴儿地高辛中毒发生率比以前认识到的更高。最近的研究表明，给新生儿和婴儿使用低剂量地高辛时会出现适当的治疗反应。对于充血性心力衰竭婴儿，最初应使用低地高辛剂量方案。如果临床反应不满意或怀疑有中毒，应测定稳态血清浓度并调整剂量。
