Maintenance Digoxin in Elderly Patients

Dall, J. L. C.

doi:10.1136/bmj.2.5711.705

Cited by 118 publications

(33 citation statements)

References 4 publications

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“…In another study performed by Dall (1970) involving elderly patients on maintenance digoxin doses, about 34%, had to stop the treatment because of toxic effects, such as arrhythmias, nausea and vomiting, mental confusion, refractory cardiac failure, gynaecomastia and xanthopsia.…”

Section: Digitalismentioning

confidence: 99%

Elderly and drugs: risks and necessity of rational use

Baldoni

Chequer

Ferraz

et al. 2010

Braz. J. Pharm. Sci.

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In recent decades, the world has undergone a demographic transformation with a rapid growth of the elderly population, resulting in an increased demand for funds to maintain their health and drug consumption. Pharmacokinetic and pharmacodynamic changes occurring in the elderly can interfere directly in the adverse effects of drugs and increase the risk of intoxication. In addition, there are external factors interfering with the pharmacotherapy of the elderly, such as inappropriate use and the lack of access to information. Many therapeutic classes of drugs should be used with caution or avoided in the elderly population, such as anti-inflammatory and some anti-hypertensive drugs, diuretics and digitalis. If not managed carefully, these medicines can affect the safety and quality of life in the elderly. Thus, the aim of this review was to identify drugs that should be used with caution in elderly patients in order to avoid intoxication and/or adverse drug events.Uniterms: Elderly/inappropriate medicines. Medicines/consumption. Medicines/adverse reaction. Medicines/intoxication. Medicine/rational use. Medicine/inappropriate prescribing.Durante as últimas décadas, o mundo passou por uma transformação demográfica, com um rápido crescimento da população idosa e, portanto, tanto a demanda para a manutenção da saúde deste grupo populacional, quanto o consumo de medicamentos estão aumentando. Ainda, as mudanças farmacocinéticas e farmacodinâmicas que ocorrem em idosos podem interferir diretamente nos efeitos adversos dos medicamentos e aumentar o risco de intoxicação. Além disso, há fatores externos que interferem na farmacoterapia dos idosos, tais como o uso inadequado e a falta de acesso à informação. Existem várias classes terapêuticas de medicamentos que devem ser utilizados com cautela ou evitados na população idosa, tais como antiinflamatórios, alguns anti-hipertensivos, diuréticos, digitálicos entre outros. Estes medicamentos, se não forem utilizados com cuidado, podem afetar a qualidade de vida e a segurança desta população. Assim, este trabalho visa identificar medicamentos que devem ser utilizados com cuidado em pacientes idosos para evitar intoxicações e/ou eventos adversos aos medicamentos.Unitermos: Idosos/medicamentos inadequados. Medicamentos/consumo. Medicamentos/reação adversa. Intoxicação medicamentosa. Medicamentos/uso racional. Prescrição inapropriada.

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Section: Digitalismentioning

confidence: 99%

Elderly and drugs: risks and necessity of rational use

Baldoni

Chequer

Ferraz

et al. 2010

Braz. J. Pharm. Sci.

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“…In particular, almost 20% of the patients had a plasma digoxin concentration of 0.6 nmol/l or less and it is unlikely that these patients were deriving any therapeutic benefit from the drug. Surveys carried out amongst elderly patients on long-term therapy have shown that between 48 and 77% of the patients studied could be withdrawn from digitalis therapy (Dall, 1970;Kirsten et al, 1973;Fonrose et al, 1974). It is probable, on the basis of plasma digoxin levels alone, that at least three patients in our sample could have been withdrawn from digoxin therapy and, whilst the problem of toxicity tends to be uppermost in the thoughts of clinicians when assessing digoxin therapy, our data suggest that under-digitalization should be given due consideration; patients apparently failing to respond to the drug may, in fact, have ineffective plasma levels.…”

Section: Discussionmentioning

confidence: 99%

“…All these subjects were ambulant and receiving digoxin from their general practitioner. It therefore seems worthwhile to monitor plasma digoxin concentrations within the community as well, particularly since studies have shown that, in many patients on longterm treatment, digoxin therapy may be stopped without adverse effects (Dall, 1970;Kirsten, Rodstein & Iuster, 1973;Fonrose, Ahlbaum, Bugatch, Cohen, Genovese & Kelley, 1974).…”

Section: Introductionmentioning

confidence: 99%

Digoxin measurements in general practice.

Holt¹,

Williamson²

1977

Brit J Clinical Pharma

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1 As part of a prospective study on the use of digoxin in a general practice, plasma digoxin concentrations were measured in all patients receiving the drug. 2 A low mean plasma digoxin concentration was observed, suggesting a cautious approach to digitalization. 3 The correlation between plasma digoxin concentration and signs or symptoms commonly used in the assessment of digoxin effect was poor. 4 It was concluded that the measurement of plasma digoxin could be of assistance in a variety of clinical settings within a general practice.

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“…Following withdrawal, no subjective deterioration was noted and no objective worsening of ballistocardiographic indices of cardiac function were detected. A year later, Dall et al [30] undertook a study in 80 patients whose ages ranged from 58 to 99 years. The study was uncontrolled, open in design, and some of the patients had no evidence of heart disease.…”

Section: Uncontrolled and Withdrawal Studiesmentioning

confidence: 99%

Digoxin?A redundant drug in congestive cardiac failure

Poole‐Wilson

Robinson

1989

Cardiovasc Drug Ther

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Controversy continues concerning the use of digoxin as a positive inotropic agent in the treatment of heart failure in patients in sinus rhythm. Digoxin is properly used to control the heart rate in patients in atrial fibrillation. The findings from 14 uncontrolled and 6 controlled clinical trials have been examined. Digoxin does exert a small chronic positive inotropic effect. Although some individual patients, particularly those with fluid overload, appear to benefit from digoxin, controlled clinical trials in patients, most of whom have been treated with diuretics, have failed to demonstrate an increase of exercise capacity. No mortality trial has been attempted. Digoxin has the potential to be harmful in patients with ischemic heart disease. Alternative and safer therapies have been shown to be equal or superior to digoxin.

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Maintenance Digoxin in Elderly Patients

Cited by 118 publications

References 4 publications

Elderly and drugs: risks and necessity of rational use

Elderly and drugs: risks and necessity of rational use

Digoxin measurements in general practice.

Digoxin?A redundant drug in congestive cardiac failure

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