Digoxin Use in the Elderly

Stults, Barry M.

doi:10.1111/j.1532-5415.1982.tb01297.x

Cited by 22 publications

(10 citation statements)

References 62 publications

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“…Digoxin is commonly prescribed for older patients with heart failure and cardiac arrhythmias. The increased likelihood of digoxin toxicity in the elderly has been well established 2,3 . As experience with each class of cardioactive drug used concomitantly with digoxin grows, evidence of potentially dangerous interactions becomes apparent.…”

Section: Discussionmentioning

confidence: 99%

“…Renal digoxin clearance falls by 20% from diminished tubular secretion of digoxin, 9,11 whereas extrarenal metabolism is reduced by 60% 7 . Renal digoxin clearance is decreased in healthy elderly individuals with normal serum urea and creatinine levels and may be further decreased in those with underlying renal dysfunction 2,3 …”

Section: Discussionmentioning

confidence: 99%

“…The understanding of digoxin pharmacokinetics has improved since Withering's initial observations. Yet, despite sophisticated methods of estimating its serum concentration and cardiologic effects, digoxin toxicity, especially in the elderly remains a serious cause of morbidity and mortality 2,3 …”

mentioning

confidence: 99%

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Clinical Digoxin Toxicity in the Aged in Association With Co‐Administered Verapamil

Gordon

Goldenberg

1986

J American Geriatrics Society

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Digoxin toxicity occurs more commonly in aged than younger individuals. Cardioactive drugs such as quinidine effect digoxin pharmacokinetics so as to increase the potential for digoxin toxicity. The calcium-channel antagonists have become extensively used for cardiac disorders and are often co-administered with digoxin. Despite documented calcium-channel antagonist interactions with digoxin, clinically significant digoxin toxicity associated with their concurrent use is apparently unusual. Two elderly patients receiving digoxin and verapamil simultaneously are presented to demonstrate the clinical importance and potential danger of the concomitant use of these drugs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical Digoxin Toxicity in the Aged in Association With Co‐Administered Verapamil

Gordon

Goldenberg

1986

J American Geriatrics Society

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“…This study demonstrates that maintenance digoxin is not required in most elderly nursing home patients with normal sinus rhythm and no evidence of congestive heart failure. It would seem appropriate to limit the use of digoxin to elderly patients with congestive heart failure in sinus rhythm in whom adequate diuretic therapy has failed 9 , 10 and in the elderly patients in atrial fibrillation where it may be needed to control the ventricular rate 11 , 12 …”

Section: Discussionmentioning

confidence: 99%

Digitalis Withdrawal in Elderly Nursing Home Patients

Wilkins

Khurana

1985

J American Geriatrics Society

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Nursing home patients were studied to determine the usefulness of a maintenance dose of digoxin in elderly patients with normal sinus rhythm. Of 64 patients, 26 were identified to be on digoxin. Thorough history and physical examination were done on all the patients. Baseline electrocardiogram showed normal sinus rhythm in 19 patients, who were observed very closely for the period of four months after withdrawal of digoxin. Eighteen of 19 patients did well without digoxin, which suggests that most of the elderly nursing home patients with normal sinus rhythm do not need a maintenance dose of digoxin.

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“…Between 5 and 15% of all hospitalised patients prescribed digitalis preparations develop digitalis toxicity, and more than 80% are over 60 years of age (Stults 1982). Fatigue, malaise and lethargy are the most common neuropsychiatric manifestations of digitalis toxicity.…”

Section: Digitalis Preparationsmentioning

confidence: 99%

Drug-Induced Depression in the Aged

1993

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Over 10% of medically ill elderly persons have concurrent major depression, and medical illness is the most influential stressor contributing to depression in old age. The contribution of prescribed medications to depression in the medically ill is poorly understood. Most information on drug-induced depression is derived from case reports; 43 classes of medications have been implicated, including reserpine, beta-blockers, levodopa, corticosteroids, and antipsychotics. However, large rigorously performed studies of some drugs, particularly antihypertensives, suggest that drug-induced depression is uncommon and idiosyncratic. There is no evidence that age is an independent risk factor for drug-induced depression. However, elderly persons are the largest consumers of prescribed drugs, and the burden of drug-induced depression is carried by the old. Because of the frequency of atypical presentations of mental disorders in the elderly, drug-induced depression is often misdiagnosed. Nevertheless, basic principles of geriatric medicine offer useful guidance to clinicians in evaluating the complex interrelationships between prescribed medications and depression. We recommend an approach that includes regular inquiry into the common symptoms of mood disorders, vigilance in assessing the contribution of drugs in their development, but scepticism in assessing a depressive episode as caused only by medication.

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Digoxin Use in the Elderly

Cited by 22 publications

References 62 publications

Clinical Digoxin Toxicity in the Aged in Association With Co‐Administered Verapamil

Clinical Digoxin Toxicity in the Aged in Association With Co‐Administered Verapamil

Digitalis Withdrawal in Elderly Nursing Home Patients

Drug-Induced Depression in the Aged

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