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Ther Drug Monit. 2019 Sep 30. doi: 10.1097/FTD.0000000000000704. [Epub ahead of print]

Utility of Physiologically Based Pharmacokinetic Modeling in Point of Care Decisions: An Example using Digoxin dosing in Continuous Venovenous Hemodiafiltration.

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University of North Texas System College of Pharmacy, Fort Worth, Texas, USA.
Parkland Hospital, Dallas, TX.
Methodist Charlton Medical Center, Dallas, TX 75237.


We describe the case of a patient on continuous venovenous hemodiafiltration (CVVHDF) with atrial fibrillation with rapid ventricular response (RVR) and hypotension requiring vasopressor use, which warranted digoxin therapy. In the absence of guidelines specifying appropriate digoxin dosing in patients undergoing CVVHDF, anecdotal evidence-guided digoxin dosing was performed for this patient using plasma digoxin concentration-based therapeutic drug monitoring (TDM). We use this case to demonstrate the potential role of physiologically based pharmacokinetic modeling in assisting therapeutic decision making.

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