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Related Concept Videos

Heart Failure Drugs: Inotropic Agents01:26

Heart Failure Drugs: Inotropic Agents

Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
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Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
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Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are not...
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In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
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For drugs producing a quantal response, onset occurs when plasma concentration reaches a minimum effective level (Cmin). The drug's action duration depends on how long the plasma concentration remains above Cmin.Two primary factors influence this duration: dose size and the rate of drug removal from the action site. Both depend on the drug's redistribution to poorly perfused tissues and elimination processes. A larger dose promotes rapid onset and prolongs the effect's duration.Consider a...
Pharmacokinetic–Pharmacodynamic Relationship: Influence of Elimination Half-Life on Effect Duration01:23

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Drug elimination from the body primarily occurs through metabolic and excretion pathways. Hepatic metabolism transforms lipophilic drugs into hydrophilic forms for excretion, typically via enzymatic processes classified as phase I (modification) and phase II (conjugation). Renal excretion eliminates drugs and metabolites through filtration and secretion in the kidneys. Impairment in liver or kidney function can hinder these processes, delaying drug clearance and extending the drug’s half-life.

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Updated: Jun 30, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Prolonged digitoxin half-life in very elderly patients.

T Bohmer1, A Røseth

  • 1Department of Medicine, Aker University Hospital, 0514 Oslo, Norway.

Age and Ageing
|November 22, 2005
PubMed
Summary

Elderly patients, particularly in their eighth and ninth decades, experience a significantly prolonged digitoxin half-life, leading to accumulation and potential toxicity even at low doses. This highlights the need for careful monitoring when prescribing digitoxin for heart failure in this population.

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Area of Science:

  • Pharmacology
  • Geriatric Medicine
  • Cardiology

Background:

  • Digitoxin is a cardiac glycoside used in heart failure treatment.
  • Age-related changes can affect drug metabolism and elimination.
  • Understanding drug pharmacokinetics in the elderly is crucial for safe and effective treatment.

Purpose of the Study:

  • To investigate the pharmacokinetics of digitoxin in very elderly patients.
  • To assess the risk of digitoxin accumulation and toxicity in geriatric populations.
  • To provide recommendations for digitoxin use in the elderly.

Main Methods:

  • Comparative pharmacokinetic study.
  • Measurement of digitoxin half-life in elderly (80-90 years) and younger adult patients.
  • Clinical observation of digitoxin accumulation and intoxication symptoms.

Main Results:

  • Digitoxin half-life was significantly prolonged in elderly patients (mean +/- SD: 25 +/- 9 days) compared to younger individuals (6.7 +/- 1.7 days).
  • Elderly patients accumulated digitoxin even with a low daily dose (0.05 mg).
  • Discontinuation of digitoxin led to the resolution of intoxication symptoms.

Conclusions:

  • Very elderly patients are at high risk for digitoxin accumulation and intoxication.
  • Lower doses and careful monitoring are essential when prescribing digitoxin for heart failure in the very elderly.
  • Awareness of prolonged half-life and potential toxicity is critical for clinicians treating geriatric patients with digitoxin.