[Glycoside therapy in elderly patients (author's transl)]

Area of Science:

• Gerontology
• Clinical Pharmacology
• Nephrology

Context:

• Aging is associated with declining renal function, potentially impacting drug metabolism and excretion.
• Cardiac glycosides, such as digoxin, are commonly prescribed for heart conditions.
• Elderly patients may exhibit altered drug tolerance and increased susceptibility to adverse effects.

Purpose:

• To investigate the safety and efficacy of digoxin and its derivatives in elderly patients.
• To determine appropriate dosing strategies for cardiac glycosides in older adults.
• To identify risk factors for digoxin toxicity in the geriatric population.

Summary:

• Elderly patients with normal serum creatinine levels can safely receive standard oral doses of beta-methyldigoxin, beta-acetyldigoxin, or digoxin without elevated serum glycoside concentrations.
• A normal serum creatinine level before initiating therapy is sufficient for safe glycoside treatment in the elderly.
• However, elderly patients have decreased glycoside tolerance; serum concentrations of 2.3 ng/ml or higher are associated with a higher incidence of toxic side effects (87%) compared to younger individuals (72%).
• Impaired renal function, indicated by elevated serum creatinine, is the primary cause of intoxication (75%) and must be considered in dosage adjustments.

Impact:

• This study highlights the importance of renal function assessment in elderly patients initiating cardiac glycoside therapy.
• It provides evidence-based recommendations for safe digoxin dosing in geriatrics, emphasizing individualized monitoring.
• Findings can help clinicians minimize the risk of digoxin toxicity and improve patient outcomes in older adults.