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[Blood digoxin and treatment of heart failure in aged patients]
Insights
Serum digoxin levels in elderly patients showed variability, correlating with blood nitrogen but not other factors. Individual monitoring is recommended for optimal therapeutic effectiveness.
Area of Science:
- Pharmacology
- Geriatric Medicine
- Clinical Chemistry
Context:
- Elderly patients often have altered drug pharmacokinetics.
- Digoxin is a common medication for heart conditions in older adults.
- Understanding digoxin bioavailability and effectiveness in this population is crucial.
Purpose:
- To investigate the relationship between serum digoxin levels and various factors in elderly inpatients.
- To assess the correlation between digoxin levels, therapeutic effectiveness, and patient characteristics.
- To determine the clinical utility of serum digoxin level monitoring in this demographic.
Summary:
- Serum digoxin levels were measured in 76 elderly inpatients without toxicity, revealing a correlation with blood nitrogen but not age, weight, or co-administered drugs.
- Therapeutic effectiveness was not directly dependent on digoxin levels, though higher levels were observed in patients with higher functional class (NYHA III and IV).
- Significantly lower digoxin levels were noted in patients with coronary heart disease compared to those with right ventricle overload.
Impact:
- Highlights the significant inter-individual variability in digoxin bioavailability and effectiveness in the elderly.
- Suggests that routine serum digoxin level determination can aid in personalizing treatment and optimizing therapeutic outcomes.
- Emphasizes the need for individualized monitoring to establish a baseline for effective digoxin therapy in geriatric patients.
Abstract:
Serum digoxin level was determined by radioimmunoassay in 76 elderly in-patients (age: 76.1 +/- 1.0) which were treated by digoxin without any evidence of toxicity. Digoxin levels was related to blood nitrogen (p less than 0,01); on the other hand, no relationship between others factors influencing the digoxin bioavailability (age, body weight, associated drug) and digoxin levels could be found. Therapeutic effectiveness, as estimated by ventricular rate and signs and symptoms, was not dependent of digoxin levels. In patients with higher functional class (III and IV NYHA), however, digoxin level was generally demonstrated to be increased. Digoxin levels were lower in patients with coronary heart disease (1.71 +/- 0,22 ng/ml; n = 16) than in patients with right ventricle overload (2.94 +/- 0,74 mg/ml; n + 7 - p less than 0.05). Because of the very large scattering of digoxin levels, digoxin determination seems to be useful in measuring individual bioavailability and therapeutic effectiveness, and leading to the best base line of any individual treatment.