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Digitalisation and digitalis detoxication in the elderly

F I Caird, R D Kennedy

    Age and Ageing
    |February 1, 1977
    PubMed
    Summary
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    Elderly patients with normal kidney function achieved therapeutic digoxin levels quickly without toxicity. Renal impairment significantly impacts digoxin elimination, affecting dosage and prediction models in older adults.

    Area of Science:

    • Pharmacology
    • Geriatrics
    • Cardiology

    Background:

    • Digoxin is a crucial medication for managing cardiac failure and atrial fibrillation.
    • Understanding digoxin pharmacokinetics in elderly patients is essential for safe and effective treatment.

    Purpose of the Study:

    • To investigate digoxin serum concentrations and pharmacokinetics in elderly patients.
    • To assess the impact of renal function on digoxin levels and elimination.
    • To evaluate the predictability of serum digoxin levels during digitalization.

    Main Methods:

    • Studied 23 elderly patients with normal renal function during digoxin digitalization.
    • Monitored serum digoxin concentrations over time with varying daily doses.
    • Measured serum digoxin half-times and elimination constants in six patients with severe renal impairment.

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    Main Results:

    • Therapeutic digoxin concentrations were achieved rapidly in elderly patients with normal renal function.
    • No toxic effects were observed in any patient.
    • Patients with severe renal impairment exhibited prolonged digoxin half-times (62-189 hours) and reduced elimination constants (9-27% per day).

    Conclusions:

    • Elderly patients with normal renal function can be effectively digitalized with standard digoxin doses.
    • Renal impairment significantly alters digoxin pharmacokinetics, necessitating careful dosage adjustments and prediction.
    • Established pharmacokinetic parameters allow for accurate prediction of serum digoxin levels in elderly patients.