Document Detail

Effect of Chinese medicines Chan Su and Lu-Shen-Wan on serum digoxin measurement by Digoxin III, a new digoxin immunoassay.
MedLine Citation:
PMID:  18223469     Owner:  NLM     Status:  MEDLINE    
Chan Su and Lu-Shen-Wan are Chinese medicines that crossreact with digoxin immunoassays. Recently, Abbott Laboratories released a new digoxin immunoassay, Digoxin III. We studied potential interference of Chan Su and Lu-Shen-Wan with the Digoxin III assay by comparing results obtained by using Digoxin II and fluorescence polarization immunoassay, also manufactured by Abbott Laboratories. Aliquots of a drug-free serum pool were supplemented with aqueous extract of Chan Su or Lu-Shen-Wan and apparent digoxin concentrations were measured using all three digoxin assays. Significant crossreactivity of Chan Su and Lu-Shen-Wan was observed with the new Digoxin III assay. Moreover, when mice were fed with Chan Su or Lu-Shen-Wan, significant apparent digoxin concentrations were also observed in the sera of mice using the Digoxin III assay indicating that such interferences are also present in vivo. When serum pools prepared from patients receiving digoxin were further supplemented with Chan Su or Lu-Shen-Wan extract, falsely elevated digoxin values were observed with both Digoxin III and fluorescence polarization immunoassay, but digoxin values were falsely lowered using the Digoxin II assay. For example, when one aliquot of Digoxin Serum Pool 1 containing 0.94 ng/mL of digoxin was supplemented with 5.0 microg/mL of Chan Su extract, the digoxin concentration was falsely elevated to 6.60 ng/mL as measured by the Digoxin III assay and 6.99 as measured by the fluorescence polarization immunoassay assay. In contrast, the observed digoxin value was falsely lowered to 0.72 ng/mL using the Digoxin II assay. Interference of Chan Su and Lu-Shen-Wan in the Digoxin III assay cannot be eliminated by monitoring free digoxin concentrations. Digibind neutralizes digoxin-like immunoreactive components of Chan Su and such effect can be monitored by measuring apparent free digoxin concentrations using the Digoxin III assay. We conclude the both Chan Su and Lu-Shen-Wan significantly interfere with serum digoxin measurements by the new Digoxin III assay.
Meredith A Reyes; Jeffrey K Actor; Semyon A Risin; Amitava Dasgupta
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Therapeutic drug monitoring     Volume:  30     ISSN:  0163-4356     ISO Abbreviation:  Ther Drug Monit     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-01-28     Completed Date:  2008-05-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7909660     Medline TA:  Ther Drug Monit     Country:  United States    
Other Details:
Languages:  eng     Pagination:  95-9     Citation Subset:  IM    
Department of Pathology and Laboratory Medicine, University of Texas Health Sciences Center at Houston, Houston, Texas 77030, USA.
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MeSH Terms
Bufanolides / blood*
Cross Reactions
Digoxin / blood*
Dose-Response Relationship, Drug
Drugs, Chinese Herbal / analysis*
False Negative Reactions
False Positive Reactions
Fluorescence Polarization
Herb-Drug Interactions
Sensitivity and Specificity
Reg. No./Substance:
0/Bufanolides; 0/Drugs, Chinese Herbal; 0/chan su; 20830-75-5/Digoxin; 465-21-4/bufalin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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