Effects of multiple doses of montmorillonite, alone and in combination with activated charcoal, on the toxicokinetics of a single dose of digoxin in rats

Objective(s): A narrow margin between the therapeutic and toxic doses of digoxin can result in an increased incidence of toxicity.  Since digoxin has an enterohepatic cycle, multiple oral doses of absorbents like montmorillonite may be useful in the treatment of digoxin toxicity.Materials and Method...

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Main Authors: Fatemeh Heydarian, Mohamad Moshiri, Ali Roohbakhsh, Maryam Akaberi, Atoosa Haghighizadeh, Ameneh Ghadiri, Negar Yeganeh Khorasani, Leila Etemad
Format: Article
Language:English
Published: Mashhad University of Medical Sciences 2023-08-01
Series:Iranian Journal of Basic Medical Sciences
Subjects:
Online Access:https://ijbms.mums.ac.ir/article_22479_573816ef5ae8e6d3fac3cd04bc967705.pdf
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author Fatemeh Heydarian
Mohamad Moshiri
Ali Roohbakhsh
Maryam Akaberi
Atoosa Haghighizadeh
Ameneh Ghadiri
Negar Yeganeh Khorasani
Leila Etemad
author_facet Fatemeh Heydarian
Mohamad Moshiri
Ali Roohbakhsh
Maryam Akaberi
Atoosa Haghighizadeh
Ameneh Ghadiri
Negar Yeganeh Khorasani
Leila Etemad
author_sort Fatemeh Heydarian
collection DOAJ
description Objective(s): A narrow margin between the therapeutic and toxic doses of digoxin can result in an increased incidence of toxicity.  Since digoxin has an enterohepatic cycle, multiple oral doses of absorbents like montmorillonite may be useful in the treatment of digoxin toxicity.Materials and Methods: In this study, 4 groups of 6 rats received intraperitoneal digoxin (1 mg/kg), and half an hour later, distilled water (DW) or oral adsorbents, including montmorillonite (1 g/kg), activated charcoal (1 g/kg) (AC) alone or in combination in the ratio of 70:30. Half of the mentioned doses were also gavaged at 3 and 5.5 hr after digoxin injection. The serum level of digoxin, biochemical factors, and activity score were assessed during the experiment. Three control groups only received DW, montmorillonite, or AC.Results: All adsorbents were able to significantly decrease the serum level of digoxin compared to the digoxin+DW group (P<0.01). Only montmorillonite reversed the digoxin-induced hyperkalemia (P<0.05). Multiple dose administration of adsorbents also significantly reduced the digoxin area under the curve and half-life and increased digoxin clearance (P<0.05). However, there was no significant difference in the kinetic parameters between groups that received digoxin plus adsorbents.Conclusion: Multiple-dose of montmorillonite reversed digoxin toxicity and reduced serum digoxin levels by increasing the excretion and reducing the half-life. Montmorillonite has also corrected digoxin-induced hyperkalemia.  Based on the findings, a multiple-dose regimen of oral montmorillonite could be a suitable candidate for reducing the toxicity issue associated with drugs like digoxin that undergo some degree of enterohepatic circulation.
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spelling doaj.art-d16b304d558447ac89af8527825e45892023-09-17T06:59:09ZengMashhad University of Medical SciencesIranian Journal of Basic Medical Sciences2008-38662008-38742023-08-0126890691110.22038/ijbms.2023.66843.1466122479Effects of multiple doses of montmorillonite, alone and in combination with activated charcoal, on the toxicokinetics of a single dose of digoxin in ratsFatemeh Heydarian0Mohamad Moshiri1Ali Roohbakhsh2Maryam Akaberi3Atoosa Haghighizadeh4Ameneh Ghadiri5Negar Yeganeh Khorasani6Leila Etemad7Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, IranDepartment of Clinical Toxicology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IranPharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, IranDepartment of Pharmacognosy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, IranDepartment of Pharmaceutical and Food Control, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, IranPharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, IranStudent Research Committee, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, IranInternational UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranObjective(s): A narrow margin between the therapeutic and toxic doses of digoxin can result in an increased incidence of toxicity.  Since digoxin has an enterohepatic cycle, multiple oral doses of absorbents like montmorillonite may be useful in the treatment of digoxin toxicity.Materials and Methods: In this study, 4 groups of 6 rats received intraperitoneal digoxin (1 mg/kg), and half an hour later, distilled water (DW) or oral adsorbents, including montmorillonite (1 g/kg), activated charcoal (1 g/kg) (AC) alone or in combination in the ratio of 70:30. Half of the mentioned doses were also gavaged at 3 and 5.5 hr after digoxin injection. The serum level of digoxin, biochemical factors, and activity score were assessed during the experiment. Three control groups only received DW, montmorillonite, or AC.Results: All adsorbents were able to significantly decrease the serum level of digoxin compared to the digoxin+DW group (P<0.01). Only montmorillonite reversed the digoxin-induced hyperkalemia (P<0.05). Multiple dose administration of adsorbents also significantly reduced the digoxin area under the curve and half-life and increased digoxin clearance (P<0.05). However, there was no significant difference in the kinetic parameters between groups that received digoxin plus adsorbents.Conclusion: Multiple-dose of montmorillonite reversed digoxin toxicity and reduced serum digoxin levels by increasing the excretion and reducing the half-life. Montmorillonite has also corrected digoxin-induced hyperkalemia.  Based on the findings, a multiple-dose regimen of oral montmorillonite could be a suitable candidate for reducing the toxicity issue associated with drugs like digoxin that undergo some degree of enterohepatic circulation.https://ijbms.mums.ac.ir/article_22479_573816ef5ae8e6d3fac3cd04bc967705.pdfantidotesbentonitecharcoaldigoxinpoisoningtoxicokinetics
spellingShingle Fatemeh Heydarian
Mohamad Moshiri
Ali Roohbakhsh
Maryam Akaberi
Atoosa Haghighizadeh
Ameneh Ghadiri
Negar Yeganeh Khorasani
Leila Etemad
Effects of multiple doses of montmorillonite, alone and in combination with activated charcoal, on the toxicokinetics of a single dose of digoxin in rats
Iranian Journal of Basic Medical Sciences
antidotes
bentonite
charcoal
digoxin
poisoning
toxicokinetics
title Effects of multiple doses of montmorillonite, alone and in combination with activated charcoal, on the toxicokinetics of a single dose of digoxin in rats
title_full Effects of multiple doses of montmorillonite, alone and in combination with activated charcoal, on the toxicokinetics of a single dose of digoxin in rats
title_fullStr Effects of multiple doses of montmorillonite, alone and in combination with activated charcoal, on the toxicokinetics of a single dose of digoxin in rats
title_full_unstemmed Effects of multiple doses of montmorillonite, alone and in combination with activated charcoal, on the toxicokinetics of a single dose of digoxin in rats
title_short Effects of multiple doses of montmorillonite, alone and in combination with activated charcoal, on the toxicokinetics of a single dose of digoxin in rats
title_sort effects of multiple doses of montmorillonite alone and in combination with activated charcoal on the toxicokinetics of a single dose of digoxin in rats
topic antidotes
bentonite
charcoal
digoxin
poisoning
toxicokinetics
url https://ijbms.mums.ac.ir/article_22479_573816ef5ae8e6d3fac3cd04bc967705.pdf
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