The effect of age on digitoxin pharmacokinetics.

Donovan, MA; Castleden, C. M.; Pohl, J. E. F.; Kraft, CA

doi:10.1111/j.1365-2125.1981.tb01144.x

Cited by 11 publications

(3 citation statements)

References 10 publications

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“…The pharmacokinetics of digoxin are altered in the elderly 159 . Absorption of digoxin in tablet form is 80% at maximum, but considerable variation exists.…”

Section: Treatmentmentioning

confidence: 99%

Congestive Heart Failure in the Elderly

Luchi¹,

Taffet²,

Teasdale³

1991

J American Geriatrics Society

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“…The pharmacokinetics of digoxin are altered in the elderly 159 . Absorption of digoxin in tablet form is 80% at maximum, but considerable variation exists.…”

Section: Treatmentmentioning

confidence: 99%

Congestive Heart Failure in the Elderly

Luchi¹,

Taffet²,

Teasdale³

1991

J American Geriatrics Society

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“…The half-life of digitoxin in six free-living healthy elderly people with a mean age of 71 years •was 8.3 days [13]. However, these results can not be extrapolated to patients in their eight and ninth decade.…”

Section: Discussionmentioning

confidence: 88%

Prolonged digitoxin half-life in very elderly patients

Bøhmer¹,

Røseth²

1998

Age Ageing

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The digitoxin half-life in elderly patients in the eight and ninth decade was more prolonged (mean +/- SD: 25 +/- 9 days) than in younger people (6.7 +/- 1.7). These elderly patients accumulated digitoxin even on a dose of 0.05 mg/ day. The symptoms of digitoxin intoxication disappeared on discontinuation of medication. When digitoxin is used in the treatment for heart failure in the very elderly patients, one should be aware of the possibility of digitoxin intoxication, even on a low dose.

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“…In contrast to digitoxin (Donovan et al 1981), digoxin undergoes decreased clearance with deterioration of renal function with age. In addition, the volume of distribution of digoxin is reduced due to a decrease in lean body mass (Chellingsworth 1986), but intestinal absorption and biliary excretion of digoxin metabolites are usually not altered.…”

Section: Effect Of Agementioning

confidence: 93%

Digitalis

Mooradian

1988

Clinical Pharmacokinetics

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The intestinal absorption of digoxin is essentially a passive non-saturable diffusion process, although a saturable carrier-mediated component also plays an important role. The bioavailability varies between 40 and 100%: the presence of food may reduce the peak serum concentration, but does not reduce the amount of digoxin absorbed. Recent development of a capsule containing a hydroalcoholic vehicle may reduce interindividual variations in absorption. Pharmacokinetic analysis of the distribution of digoxin suggests 3 compartments, the slow distribution phase accounting for the lag time between the inotropic effects and the plasma concentration profile. Digoxin is extensively bound to tissues such as myocardium, renal, skeletal muscle as well as red blood cells, but not to adipose tissue. Plasma protein binding varies between 20 and 30%: displacement of digoxin from protein binding sites does not cause significant clinical effects. As expected, haemodialysis or exchange transfusions do not significantly alter the body load of digoxin. The apparent volume of distribution of digoxin varies between 5 and 7.3 L/kg; this may be reduced by, for example, electrolyte abnormalities which reduce digoxin binding to the myocardium. The elimination half-life of digoxin is 36 hours, with 60 to 80% being excreted unchanged, by passive glomerular filtration and active tubular secretion. The remainder is excreted non-renally. Clearance is therefore dependent on renal function and declines in renal disease and in elderly patients. Digoxin interacts with other drugs at any stage of absorption (e.g. cholestyramine), distribution (e.g. quinidine), metabolism (e.g. phenytoin) or elimination (e.g. diltiazem). Patients should, therefore, be carefully monitored when changing a therapeutic regimen which includes any drugs known to interact with digoxin. Clinical monitoring is more important than therapeutic drug monitoring which should be reserved for suspected toxicity, doubts about efficacy, or in cases of poor compliance. With the advent of newer treatment modalities, digoxin is no longer the treatment of first choice in supraventricular arrhythmias and congestive heart failure. However, with careful monitoring, digoxin remains an important therapeutic option.

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The effect of age on digitoxin pharmacokinetics.

Cited by 11 publications

References 10 publications

Congestive Heart Failure in the Elderly

Congestive Heart Failure in the Elderly

Prolonged digitoxin half-life in very elderly patients

Digitalis

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