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November 1989

Activated Charcoal Should Replace the Resins in the Treatment of Digoxin Intoxication!

Author Affiliations

Helsinki, Finland

Arch Intern Med. 1989;149(11):2603. doi:10.1001/archinte.1989.00390110145033

To the Editor.—We would like to respond to a recent article by Henderson and Solomon1 dealing with the use of cholestyramine and colestipol in the treatment of digoxin intoxication. According to their finding, the half-life of digoxin was decreased from 75.5 to 19.9 hours while cholestyramine was administered. They state that cholestyramine and colestipol interrupt the enterohepatic recycling of digoxin, representing "potentially useful adjunctive measures in the management of non–life-threatening digitalis intoxication."

Our objections and/or reservations are as follows: (1) The half-life of 19.9 hours during cholestyramine administration was based on two determinations only (2.18 nmol/L and 1.49 nmol/L; the samplings were about 10 hours apart). It is not acceptable to calculate a half-life from two data points only, and it is well known that the accuracy (and specificity in uremia) of the digoxin radioimmunoassay methods is limited. Furthermore, the general condition of the patient, and possibly the

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