Safe and effective use of digoxin in old age

Abstract

Digoxin is a common cause of drug-related visits to emergency departments and of hospital admissions. This article promotes the safe prescribing of digoxin by reviewing appropriate indications for its use, manifestations of toxicity, appropriate dosing, therapeutic drug monitoring and clinical monitoring. The Digitalis Intervention Group trial and its post-hoc analyses have helped to redefine a lower and narrower therapeutic digoxin level of 0.6-1.2 nmol/L (0.5-0.9 ng/mL) in the treatment of heart failure. To ensure appropriate dosing clinicians must take into account inter-individual and intra-individual variability in pharmacokinetics and pharmacodyamics, which occur more commonly in older people. © 2010 Rila Publications Ltd.