Altered Distribution of Digoxin in Renal Failure--A Cause of Digoxin Toxicity?

Br J Clin Pharmacol. 1976 Dec;3(6):1045-51. doi: 10.1111/j.1365-2125.1976.tb00356.x.


Three cases are described in which renal failure was accompanied by a lowered apparent volume of distribution of digoxin. In two cases this resulted in frank digoxin toxicity and in one equivocal toxicity. In all three cases digoxin plasma levels were greater than 2 ng/ml. The possible causes of the abnormal distribution of digoxin in renal failure are discussed. Recommendations are outlined for the use of digoxin in patients with renal failure aimed at circumventing the problem raised by a lowered apparent volume of distribution of the drug.

Publication types

  • Case Reports

MeSH terms

  • Cardiotonic Agents / pharmacokinetics*
  • Digoxin / pharmacokinetics*
  • Digoxin / toxicity
  • Female
  • Humans
  • Male
  • Middle Aged
  • Renal Insufficiency / metabolism*
  • Sodium-Potassium-Exchanging ATPase / antagonists & inhibitors
  • Sodium-Potassium-Exchanging ATPase / metabolism


  • Cardiotonic Agents
  • Digoxin
  • Sodium-Potassium-Exchanging ATPase