Digoxin Therapy in the Elderly: Pharmacokinetic Considerations in Nursing

Impact of Specific Beers Criteria Medications on Associations between Drug Exposure and Unplanned Hospitalisation in Elderly Patients Taking High-Risk Drugs: A Case-Time-Control Study in Western Australia

“…In the early 1970s, toxicity was of major concern in people taking digoxin, one study reporting that 25% of patients taking this PIM were diagnosed with definite toxicity [81]. Symptoms of toxicity include acute fatigue, anorexia, nausea, visual disturbances, confusion, drowsiness and others [81,82].…”

“…Subsequently, recommended dosage levels were lowered, and by the mid-1990s, the prevalence of digoxin toxicity had been reduced to ~4% in patients being treated with this medication [81]. Nonetheless, patients with renal failure remain at higher risk, as well as those taking diuretics and calcium channel blockers [81,82]. Digoxin toxicity is not the only potential adverse effect associated with this PIM, however.…”

“…to complete heart block in some situations, whereas digoxin with beta-blockers may induce bradycardia [80,82].…”

“…However, it may lead to a heart block in combination with a calcium channel blocker, as per digoxin [82]. Additionally, amiodarone may interact with other drugs through the inhibition of cytochrome P450 enzymes, increasing patients' sensitivity to most NSAIDs, warfarin, beta-blockers, calcium channel blockers, statins and a number of benzodiazepines (e.g.…”