Forty-one horses were treated for atrial fibrillation (AF) with 22 mg/kg quinidine sulfate via nasogastric tube every 2 hours until conversion to sinus rhythm, a cumulative dose of 88 to 132 mg/kg had been administered in 2-hour increments, or the horse had adverse or toxic effects from the drug. Treatment intervals were prolonged to every 6 hours if conversion had not occurred. Digoxin was administered before treatment if the horse had a fractional shortening or = 60 beats/min) (1 horse), or had a previous history of sustained tachycardia of over 100 beats/min during prior conversion (3 horses). Digoxin was administered during day 1 of quinidine sulfate treatment if the horse developed a sustained tachycardia of over 100 beats/min during treatment (11 horses) or on day 2 if conversion had not occurred (7 horses). Plasma quinidine concentrations within 1 hour of conversion of AF to sinus rhythm ranged from 1.7 to 7.5 micrograms/mL (mean, 4.05 +/- 1.6) and ranged from 1.7 to 4.7 micrograms/mL in 97% of horses. Most horses (92%) with plasma quinidine concentrations > 5 micrograms/mL exhibited an adverse or toxic effect of quinidine sulfate (clinical or electrocardiographic). There was no statistical association between plasma quinidine concentrations and sustained tachycardia (> 100 beats/min), diarrhea, or colic. Ataxia and upper respiratory tract stridor were significantly associated with plasma quinidine concentrations. In most instances (98%) conversion did not occur while toxic or adverse effects of quinidine sulfate were present or when plasma quinidine concentrations were > 5 micrograms/mL.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1939-1676.1995.tb03274.x

Treatment of atrial fibrillation in horses: new perspectives.

Chapter 8 – Disorders of the Cardiovascular System

Disorders of the cardiovascular system

The rational therapy of cardiovascular disease in horses requires a thorough knowledge of the pharmacology and pharmacokinetics of several specific drugs (digitalis, digoxin). Calcium solutions, dopamine, and dobutamine are frequently used to treat congestive heart failure in horses. Quinidine, procainamide, lidocaine, and propranolol are used to treat a variety of supraventricular and ventricular arrhythmias. Furosemide, a highly potent loop diuretic, is used to eliminate edema and promote diuresis. A thorough understanding of the applied pharmacology, dosage recommendations, toxicity, and practical considerations must be attained before these drugs can be used effectively.

Pharmacology and pharmacokinetics of drugs used to treat cardiac disease in horses.

Clinical evaluation and management of heart disease

Digoxin was administered orally and intravenously to seven healthy adult mares and geldings in two separate trials. At a dose of 44 microgram digoxin/kg body weight, the oral study was characterized by an absorption phase with a mean (+/- 1 standard deviation) peak serum digoxin concentration of 2.21 ng/ml (+/- 0.45) at a mean of 2.29 h (+/- 1.52) after administration. A second rise in serum digoxin concentration started about 6-8 h after administration and extended to about 20 h after administration. The mean bioavailability (F) was 23.38% (+/- 5.96). At a dose of 22 microgram digoxin/kg body weight, the intravenous study was characterized by a two-compartment model with the following mean pharmacokinetic measurements: distribution rate constant (alpha), 1.391 h-1 (+/- 0.1909); zero-time serum digoxin concentration determined from the distribution phase (A), 21.247 ng/ml (+/- 5.6614); elimination rate constant (beta), 0.0409 h-1 (+/- 0.0069); zero-time serum digoxin concentration determined from the elimination phase (B), 3.82 ng/ml (+/- 0.433); apparent specific volume of distribution uncorrected for protein binding (Vd beta), 5.003 l/kg (+/- 0.5177). The mean beta corresponded to a biological half-life (T1/2 beta) of 16.9 h. Based upon results of this study, theoretically achievable steady-state serum digoxin concentrations were calculated for maintenance doses given by oral and intravenous routes of administration with appropriate two-compartment, multiple-dose formulae. Loading doses were also calculated for each route. It is the opinion of the authors that the oral route of administration of digoxin is effective in the horse and may preclude the potential risks posed by the high serum digoxin concentrations immediately following intravenous administration.

L. Reed Enos

Papers

A pharmacokinetic study of digoxin in the horse.