Digoxin is considered safe to use in the elderly as long as the dose is no greater than 0.125 milligram (mg) or 125 mcg per day.
The elderly are at an increased risk of digoxin toxicity. Low dosages of digoxin appear to be effective in the treatment of heart failure due to systolic dysfunction and may reduce the incidence of digitalis toxicity in these patients. In elderly patients with AF and inadequate rate control who are receiving digitalis monotherapy, adding another atrioventricular nodal blocking drug may be more appropriate than increasing the digoxin dose, in order to avoid toxic digoxin levels. Digoxin (Lanoxin®) is prescribed in the elderly to treat common cardiac diseases including atrial fibrillation and heart failure. The elderly are at increased risk of toxicity due to age-related and disease-related changes in physiology. The half-life of digoxin is prolonged in the elderly. Signs of toxicity in the elderly include heart block, cardiac arrhythmias, anorexia, vision changes (blurred), confusion and depression. Elderly patients on digoxin require vigilant monitoring for adverse effects. Your healthcare provider will calculate a starting dosage of digoxin. For adults and children age 10 and up, the typical amounts will range from 62.5 to 500 mcg daily, depending on weight and your kidney function. Most people will likely be maintained on a dosage between 0.125 mg and 0.25 mg to achieve this level. Digoxin toxicity is likely to occur if levels exceed 2 ng per mL. It normally takes one to three weeks after you start digoxin treatment for an adequate amount of the drug to accumulate in your body. Digoxin may be adequate as monotherapy for ventricular rate control in patients with chronic AF, particularly in sedentary and elderly patients. A beta-blocker or calcium antagonist (either alone or in combination with digoxin) is indicated when digoxin is ineffective for ventricular rate control. In elderly patients with AF and inadequate rate control who are receiving digitalis monotherapy, adding another atrioventricular nodal blocking drug may be more appropriate than increasing the digoxin dose, in order to avoid toxic digoxin levels. Serum levels of digoxin may not be a good indicator of potential for toxicity. Signs of toxicity in the elderly include heart block, cardiac arrhythmias, anorexia, vision changes (blurred), confusion and depression. Elderly patients on digoxin require vigilant monitoring for adverse effects. 1  Monitor patients on digoxin vigilantly for adverse effects When, and when not, to use digoxin in the elderly. Gosselink AT(1), van Veldhuisen DJ, Crijns HJ. Author information: (1)Department of Cardiology/Thoraxcenter, University Hospital Groningen, The Netherlands. In elderly patients with AF and inadequate rate control who are receiving digitalis monotherapy, adding another atrioventricular nodal blocking drug may be more appropriate than increasing the digoxin dose, in order to avoid toxic digoxin levels. Heart Failure. As per ACCF/AHA guidelines, a loading dose to initiate digoxin therapy in patients with heart failure is not necessary. 0.125-0.25 mg PO/IV qDay; higher doses including 0.375-0.5 mg/day rarely needed. Use lower end of dosing (0.125 mg/day) in patients with impaired renal function or low lean body mass Digoxin is considered safe to use in the elderly as long as the dose is no greater than 0.125 milligram (mg) or 125 mcg per day. As we age, our kidney function changes and normally slows, so our bodies can't get rid of certain substances, like digoxin, as quickly as they once could have. Digoxin, sold under the brand name Lanoxin, is a prescription drug used to help treat irregular heartbeat and improve symptoms of fatigue caused by heart failure. Digoxin Metabolism in the Elderly By GOBDON A. Ewy, M.D., GEETA G. K.APADiA, PH.D., LINDA YAO,MURIEL LULLIN, AND FRANx I. MARCUS, M.D.SUMMARYTritiated digoxin (0.5 mg) was given intravenously to five elderly men (mean age,77years) andnineyoung men (meanage, 27years). Theelderly were not in congestiveheart failure. Since the major route of digoxin D0- ° Old excretion is the kidneys vith little drug in-activation by biotransformation,27 it is un-o- derstandable that digoxin excretion would 0- be reduced in patients with decreased renalfunction.
http://www.ncbi.nlm.nih.gov/pubmed/9205847 http://www.virginiageriatrics.org/consult/medications/not8.html http://congestive-heart-failure.emedtv.com/digoxin/digoxin-dosage.html http://www.ncbi.nlm.nih.gov/pubmed/9205847 http://www.virginiageriatrics.org/consult/medications/not8.html http://www.ncbi.nlm.nih.gov/pubmed/9205847 http://reference.medscape.com/drug/lanoxin-digoxin-342432 http://www.everydayhealth.com/drugs/digoxin http://circ.ahajournals.org/content/39/4/449.full.pdf
typical dose of digoxin for elderly