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Digoxin Therapy in the Fetus

JULIAN E. DE LIA, MD; MAURICE G. EMERY, PHARMD
Am J Dis Child. 1986;140(10):974-975. doi:10.1001/archpedi.1986.02140240020015.
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Sir.—We read with interest the article by Wiggins et al1 concerning fetal cardiac abnormalities and their in utero treatment with digoxin. Although the authors provide invaluable information on the usefulness of fetal echocardiography, we disagree with some of their conclusions concerning digoxin therapy in the fetus.

Our interest in this area was sparked by a twin pregnancy complicated by twin transfusion syndrome, in which maternal administration of digoxin reversed the ultrasonographic signs of heart failure in the recipient twin.2 At that time, a review of the literature for pharmacokinetic data to direct our therapy produced disappointing results. Despite multiple case reports demonstrating the benefits of digoxin in fetal heart failure caused by tachyarrhythmias, rarely was pharmacokinetic information reported, such as patient's weight (from which desired total-body glycoside stores could be determined), creatinine clearance (from which daily loss and maintenance dose is calculated), or time since last dose

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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