Monitoring Free Digoxin Concentration

Digoxin is a cardioactive drug which is only 25% bound to serum proteins (mainly albumin). Monitoring free digoxin concentration can be useful only under special circumstances: (a) in patients overdosed with digoxin and being treated with Fab fragment of antidigoxin antibody (digibind) and (b) to eliminate interference of endogenous digoxin-like immunoreactive factors on serum digoxin measurement. Certain Chinese medicines such as Chan Su, Dan Shen, and Ginsengs may interfere with digoxin immunoassays. Moreover, therapy with spironolactone or potassium canrenoate can cause significant interference in serum digoxin measurement using immunoassays. These issues are discussed in detail in Chapter 6.

3. monitoring concentrations of free anticonvulsants

Anticonvulsants such as phenytoin, carbamazepine, and valproic acid are strongly protein bound, mainly to albumin. Clinical utility of monitoring free phenytoin, free carbamazepine, and free valproic acid has been well documented in the literature, and many clinical laboratories offer free phenytoin, carbamazepine, and valproic acid determinations in their test menu. Moreover, the College of American Pathologists also has free anticonvulsant levels in their external survey specimens, and assay kits are commercially available for monitoring free levels of phenytoin, carbamazepine, and valproic acid.

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