From:
fzylogic@hotmail.com
Date: 2005-09-28 04:14:25 UTC
Subject: RE: digoxin and cardiomyopathy
To: ferrethealth@smartgroups.com
Message-ID: <32269974.1127881182587.JavaMail.nobody@chromium.smartgroups.com>
I can only tell you how things have gone for my 6 yr old after being diagnosed with
dilated cardio in June. Her heart measurements were within normal ranges with the
following exceptions: STd, STs, and FS (very low at 13.24%). She was on Enalapril
and Lasix for about two weeks and then switched to Benazepril because of
suspected kidney disease and alcohol-free Lasix. A few weeks later we added
Digoxin (0.07ML once a day of a 0.125MG/ML suspension). I was very concerned
because she rarely ever let anyone draw blood without using Iso in the past and
finally got to the point where she wouldn't at all. Nobody locally would test her level
because 1) they would not use Iso and 2) they didn't trust the reference ranges
provided by the labs (they use cat values) since there aren't any for ferrets. I
eventually talked the vets into letting me restrain her and she does very well. She
was on Digoxin for at least a month before being tested and her level came back at
0.4 which is low. The cardiologist that was consulted had suggested a dose of
0.09ML twice a day but the local vet wasn't comfortable with that and I haven't been
brave enough to increase it to twice a day yet. Mainly because I wanted to treat her
for Helicobacter but was told by a reputable ferret vet that Biaxin can increase the
level.
The vet used [ Lab name] and this is what is printed on my report: Therapeutic
serum digoxin levels should be measured once steady state is achieved (at least 6
days after commencing treatment) The optimal therapeutic range for digoxin levels
is 0.8-2.0 ng/mL 6 to 8 hours post-administration. Digoxin levels > 2.5 ng/mL are
commonly associated with toxic signs. The administration of diuretic or angiotensin
converting enzyme (ACE) inhibitors, hypokalemia, or azotemia will increase the
frequency of toxicity; therefore careful monitoring is necessary.
She is also on a high dose of Lasix. We tried to decrease it 2 weeks after she was
diagnosed but she had respiratory problems almost immediately. I got her stabilized
and tried to decrease it again and the problem returned but not as quickly. I try to
monitor her respirations frequently and feel she is doing okay as long as they are
between 36-40. If they are above 40-42 and her next dose isn't due for several
hours I usually give a very tiny one. Thankfully the high dose hasn't caused any
problems with the Digoxin.
The 2nd edition of Ferrets, Rabbits and Rodents has a lot of info on cardiovascular
disease and lists a starting dose for Digoxin and when and how to test the level (pgs
58-66).
Good luck.