Hemoperfusion in the Management of Digoxin Toxic Reaction

To the Editor.—  Smiley and associates (240:2736,1978) recommend hemoperfusion as a standard treatment of digoxin intoxication. According to our own investigations¹ and those of others,^2,3 we agree with these results as far as high clearance rates for digoxin are concerned. But in our opinion, plasma clearance is only one factor attributing to the efficiency of hemoperfusion. At least as important is the plasma-tissue distribution of the drug that is to be eliminated. Less than 1% of the total body pool of digoxin (normal range, 1 to 2 mg) is accumulated in the plasma (normal concentration, 1 to 2 ng—L).In our experimental model, we used dogs because their digoxin pharmacokinetics are comparable with those in humans.^4,5 In 12 dogs (body weight, 20 to 25 kg) chronically digitalized with 0.05 mg/kg of digoxin intravenously for three days before the hemoperfusion experiment, we tested the influence of the absorbent