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Comparing the toxicity of digoxin and digitoxin in a geriatric population: should an old drug be rediscovered?
C Roever1, J Ferrante, E C Gonzalez
1Department of Family Medicine, University of South Florida and the H. Lee Moffitt Cancer Center and Research Institute, Tampa 33612, USA.
Insights
Elderly patients taking digitoxin experienced lower cardiac glycoside toxicity rates compared to those on digoxin. This study highlights digitoxin as a potentially safer option for this demographic.
Area of Science:
- Geriatric Medicine
- Clinical Pharmacology
- Cardiology
Background:
- Limited data exists on cardiac glycoside toxicity in elderly patients.
- Digoxin and digitoxin are the primary cardiac glycosides used.
Purpose of the Study:
- To compare the toxicity rates of digoxin and digitoxin in elderly patients.
- To identify potential differences in adverse events between these two cardiac glycosides in geriatric populations.
Main Methods:
- Retrospective analysis of patient charts for individuals over 60 years old.
- Inclusion criteria: chronic management with a cardiac glycoside and hospitalization between January 1995 and January 1998.
- Toxicity defined as dose reduction or drug discontinuation due to clinical events.
Main Results:
- Digitoxin use was associated with a 7.6% toxicity rate.
- Digoxin use was associated with a higher toxicity rate of 18.3%.
- Multivariate analysis revealed a three-fold increased odds of toxicity for digoxin users compared to digitoxin users, after adjusting for other clinical factors.
Conclusions:
- Elderly patients hospitalized on digitoxin demonstrated a significantly lower incidence of toxicity compared to those on digoxin.
- Digitoxin may represent a safer therapeutic choice for cardiac glycoside treatment in the elderly population.
Background:
Little information is available regarding toxicity rates of the two available forms of cardiac glycosides (digoxin, digitoxin) when used in elderly patients.
Methods:
We retrospectively analyzed the charts of all patients more than 60 years of age who were chronically managed with a cardiac glycoside and were hospitalized during the period January 1995 through January 1998. Toxicity was defined as any clinical event that required either a reduction in dose of the drug or its discontinuance.
Results:
Toxicity occurred among 7.6% of hospitalizations in which digitoxin was used, compared with 18.3% of hospitalizations in which digoxin was used. In multivariate analysis, the odds of toxicity adjusted for other clinical characteristics were three times greater for patients taking digoxin than for patients taking digitoxin.
Conclusion:
Hospitalized elderly patients taking digitoxin had a lower rate of toxicity than those taking digoxin.