Conclusions

Both endogenous and exogenous DLIS can cause significant interference in serum digoxin measurement. DLIS causes low to moderate false increases in serum digoxin value in most digoxin immunoassays. However, FPIA (Digoxin II) showed significant interference from DLIS. Negative interference of DLIS in the MEIA digoxin assay may also be problematic because the clinician may increase the digoxin dose based on falsely low serum digoxin concentrations. Both positive and negative interferences in serum digoxin measurement can be eliminated by monitoring free digoxin concentration.

Interference in digoxin assays because of ingestion of Chinese medicines can cause more confusion. Most patients do not inform their physicians when they use alternative medicines. Present studies indicate that components of those Chinese medicines causing DLIS activity are strongly protein bound. Monitoring free digoxin may eliminate such interferences because of certain herbal supplements.

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