Computer-assisted review of digoxin therapy in the elderly

Area of Science:

• Geriatrics
• Clinical Pharmacology
• Nephrology

Background:

• Digoxin is commonly prescribed for elderly patients.
• Accurate digoxin dosing is challenging due to age-related physiological changes.
• Renal function significantly impacts digoxin elimination.

Purpose of the Study:

• To evaluate current digoxin prescribing practices in elderly patients.
• To compare established digoxin maintenance doses with computer-generated individualized schedules.
• To assess the clinical impact of dose optimization based on individual patient parameters.

Main Methods:

• Plasma digoxin concentrations were measured in 42 elderly patients.
• A computer program calculated individualized digoxin dosage schedules.
• Established maintenance doses were compared with computed doses.
• Renal function was assessed via creatinine clearance estimates.

Main Results:

• Discrepancies between measured and computed plasma digoxin levels were observed.
• Established and computed doses differed in 62% (26/42) of patients.
• Drug withdrawal or dosage revision in these patients led to clinical benefit.
• Reduced creatinine clearance correlated with impaired digoxin elimination in the elderly.

Conclusions:

• Current digoxin prescribing in the elderly often requires adjustment.
• Computer-assisted dosing and assessment of renal function (creatinine clearance) are vital for safe and effective digoxin therapy in older adults.
• Bedside estimation of creatinine clearance offers a practical approach to optimizing digoxin dosage.