Practical Tips for the Use of Digoxin in Older Adults with Chronic Heart Failure
Older adults with symptomatic HF should be prescribed digoxin in low doses starting at 0.125 mg/d. For persons with HF who are 75 years and older, are women, have renal insufficiency, are receiving large doses of diuretics, or have pulmonary edema, digoxin should be prescribed as 0.125 mg every other day. There is no need for routine laboratory testing of serum digoxin concentrations. However, if patients remain symptomatic at these low doses of digoxin, serum digoxin concentration should be checked before increasing the dose to 0.25 mg/d. Serum digoxin concentration should be checked at least 6 hours after the last dose of digoxin. If used in low doses, digoxin is unlikely to cause digoxin toxicity for older adults with HF.
Generally, for clinically stable new systolic HF patients, it may be preferable to initiate therapy with digoxin after initiation of therapy with an ACEI or an angiotensin receptor blocker, a beta-blocker, and an aldosterone antagonist, as appropriate. However, if a patient is symptomatic despite receiving above medications in appropriate dosages, and especially for patients with recurrent hospital admission due to worsening HF, digoxin should be prescribed on an initial visit. Digoxin should also be prescribed to any patients who cannot afford or tolerate an ACEI or an angiotensin receptor blocker, a beta-blocker, and an aldosterone antagonist. Digoxin should not be discontinued in those with known HF who are already receiving that drug.[28] Symptomatic patients with diastolic HF may also benefit from therapy with digoxin; it should be prescribed using a similar protocol to that described above.[23,28]
Geriatrics and Aging. 2008;11(1):37-41. © 2008 1453987 Ontario, Ltd.
Cite this: An Update on the Role of Digoxin in Older Adults with Chronic Heart Failure - Medscape - Jan 01, 2008.
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