Zeitschrift für Gerontologie und Geriatrie

, Volume 46, Issue 5, pp 479–488 | Cite as

Digitalis und Theophyllin

Alt und entbehrlich?
CME Zertifizierte Fortbildung

Zusammenfassung

Digitalis und Theophyllin gehören zu den ältesten Medikamenten in der Behandlung von Herz-Lungen-Erkrankungen. Trotz der langen Tradition ist die Evidenz widersprüchlich, teils eher negativ. Besonders groß ist das Spannungsfeld in der Geriatrie. Einerseits haben beide Substanzen noch einen Stellenwert, insbesondere in fortgeschrittenen Stadien der Erkrankungen bzw. als symptomatische Therapie, andererseits werden sie auf Listen als potenziell ungeeignete Medikamente für den älteren Patienten geführt. Der vorliegende Beitrag beleuchtet die aktuelle Datenlage zu beiden Substanzen auf Basis der aktuellen Literatur.

Schlüsselwörter

Medikation Ältere Patienten Vorhofflimmern Herzinsuffizienz Chronisch obstruktive Lungenerkrankung 

Digitalis and theophylline

Old and superfluous?

Abstract

Digitalis and theophylline are some of the oldest drugs used to treat cardiopulmonary diseases. Despite a long history, the evidence for both drugs is still inconsistent, in parts negative. In this context, geriatric medicine represents a special area of conflict. On the one hand, both drugs may play a role in the treatment of advanced heart failure and chronic obstructive pulmonary disease, particularly in the treatment of symptoms. On the other hand, both drugs are often listed as potentially inappropriate medications for the elderly. This paper discusses the evidence for both drugs based on the current literature.

Keywords

Medication Elderly Atrial fibrillation Heart failure Chronic obstructive pulmonary disease 

Literatur

  1. 1.
    Ritz E, Schoner W (2008) From Digitalis purpurea to toad skin. An historical view of digitalis-like mammalian hormones. Dtsch Med Wochenschr 133(51–52):2690–2694. DOI 10.1055/s-0028-1105877Google Scholar
  2. 2.
    Jelliffe RW (2012) Some comments and suggestions concerning population pharmacokinetic modeling, especially of digoxin, and its relation to clinical therapy. Ther Drug Monit 34(4):368–377PubMedCrossRefGoogle Scholar
  3. 3.
    Silverman ME (1989) William Withering and an account of the foxglove. Clin Cardiol 12(7):415–418PubMedCrossRefGoogle Scholar
  4. 4.
    Grosse-Brockhoff F, Hausamen TU (1975) 200 years heart therapy digitalis. William Withering and the 1st century of digitalis therapy. Dtsch Med Wochenschr 100(39):1980–1991PubMedCrossRefGoogle Scholar
  5. 5.
    Meyer KF (1974) Claude-Adolphe Nativelle. Pharmacist discovers digitaline. J Am Pharm Assoc 14(7):358–360PubMedGoogle Scholar
  6. 6.
    Minkowski O (1902) Über Theocin (Theophyllin) als Diureticum. Ther Gegenwart 43:490–493Google Scholar
  7. 7.
    Schultze-Werninghaus G, Meier-Sydow J (1982) The clinical and pharmacological history of theophylline: first report on the bronchospasmolytic action in man by S.R. Hirsch in Frankfurt (Main) 1922. Clin Allergy 12:211–215PubMedCrossRefGoogle Scholar
  8. 8.
    Hauptmann PJ, Kelly RA (1999) Digitalis. Circulation 99:1265–1270CrossRefGoogle Scholar
  9. 9.
    Ferguson DW, Berg WJ, Sanders JS et al (1989) Sympathoinhibitory responses to digitalis glycosides in heart failure patients. Direct evidence from sympathetic neural recordings. Circulation 80(1):65–77PubMedCrossRefGoogle Scholar
  10. 10.
    Rabe KF, Magnussen H, Dent G (1995) Theophylline and selective PDE inhibitors as bronchodilators and smooth muscle relaxants. Eur Respir J 8(4):637–642PubMedGoogle Scholar
  11. 11.
    Polson JB, Krzanowski JJ, Goldman AL, Szentivanyi A (1978) Inhibition of human pulmonary phosphodiesterase activity by therapeutic levels of theophylline. Clin Exp Pharmacol Physiol 5(5):535–539PubMedCrossRefGoogle Scholar
  12. 12.
    Björck T, Gustafsson LE, Dahlén SE (1992) Isolated bronchi from asthmatics are hyperresponsive to adenosine, which apparently acts indirectly by liberation of leukotrienes and histamine. Am Rev Respir Dis 145(5):1087–1091PubMedCrossRefGoogle Scholar
  13. 13.
    Ito K, Caramori G, Lim S et al (2002) Expression and activity of histone deacetylases in human asthmatic airways. Am J Respir Crit Care Med 166(3):392–396PubMedCrossRefGoogle Scholar
  14. 14.
    Camm AJ, Kirchhof P, Lip GY et al (2010) Guidelines for the management of a trial fibrillation: the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31:2369–2429PubMedCrossRefGoogle Scholar
  15. 15.
    Veldhuisen DJ van, Van Gelder IC, Ahmed A, Gheorghiade M (2013) Digoxin for patients with atrial fibrillation and heart failure: paradise lost or not? Eur Heart J (E-pub ahead of print)Google Scholar
  16. 16.
    Gosch M, Roller RE, Böhmdorfer B et al (2012) Management and therapy of atrial fibrillation in geriatric patients. Z Gerontol Geriatr 45(1):55–66PubMedCrossRefGoogle Scholar
  17. 17.
    Wyse DG, Waldo AL, DiMarco JP et al (2002) A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 347(23):1825–1833PubMedCrossRefGoogle Scholar
  18. 18.
    Packer M, Gheorghiade M, Young JB et al (1993) Withdrawal of digoxin from patients with chronic heart failure treated with angiotensin-converting-enzyme inhibitors. RADIANCE Study. N Engl J Med 329(1):1–7PubMedCrossRefGoogle Scholar
  19. 19.
    The Digitalis Investigation Group (1997) The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med 336(8):525–533CrossRefGoogle Scholar
  20. 20.
    Rathore SS, Curtis JP, Wang Y et al (2003) Association of serum digoxin concentration and outcomes in patients with heart failure. JAMA 289(7):871–878PubMedCrossRefGoogle Scholar
  21. 21.
    Rathore SS, Wang Y, Krumholz HM (2002) Sex-based differences in the effect of digoxin for the treatment of heart failure. N Engl J Med 347(18):1403–1411PubMedCrossRefGoogle Scholar
  22. 22.
    Ather S, Peterson LE, Divakaran VG et al (2011) Digoxin treatment in heart failure – unveiling risk by cluster analysis of DIG data. Int J Cardiol 150(3):264–269. DOI 10.1016/j.ijcard.2010.04.021PubMedCrossRefGoogle Scholar
  23. 23.
    Dovjak P (2013) Diastolic heart failure: heart failure with preserved ejection fraction. Z Gerontol Geriatr 46(1):71–81PubMedCrossRefGoogle Scholar
  24. 24.
    Ahmed A, Rich MW, Fleg JL et al (2006) Effects of digoxin on morbidity and mortality in diastolic heart failure: the ancillary digitalis investigation group trial. Circulation 114(5):397–403PubMedCrossRefGoogle Scholar
  25. 25.
    McMurray JJ, Adamopoulos S, Anker SD et al (2012) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 33(14):1787–1847PubMedCrossRefGoogle Scholar
  26. 26.
    Gheorghiade M, Patel K, Filippatos G et al (2013) Effect of oral digoxin in high-risk heart failure patients: a pre-specified subgroup analysis of the DIG trial. Eur J Heart Fail 15(5):551–559PubMedCrossRefGoogle Scholar
  27. 27.
    Gheorghiade M, Hall V, Lakier JB, Goldstein S (1989) Comparative hemodynamic and neurohormonal effects of intravenous captopril and digoxin and their combinations in patients with severe heart failure. J Am Coll Cardiol 13(1):134–142PubMedCrossRefGoogle Scholar
  28. 28.
    The Digitalis in Acute Atrial Fibrillation (DAAF) Trial Group (1997) Intravenous digoxin in acute atrial fibrillation. Results of a randomized, placebo-controlled multicentre trial in 239 patients. Eur Heart J 18(4):649–654CrossRefGoogle Scholar
  29. 29.
    BÄK, KBV, AWMF (2012) Nationale VersorgungsLeitlinie COPD. http://www.awmf.org/uploads/tx_szleitlinien/nvl-003l_S3_COPD_abgelaufen.pdfGoogle Scholar
  30. 30.
    Kardos P, Vogelmeier C, Worth H (2012) The new GOLD document. Pneumologie 66(8):493–496. DOI 10.1055/s-0032-1310053PubMedCrossRefGoogle Scholar
  31. 31.
    Gayan-Ramirez G, Janssens S, Himpens B, Decramer M (1995) Mechanism of theophylline-induced inotropic effects on foreshortened canine diaphragm. Eur Respir J 8(11):1915–1921PubMedCrossRefGoogle Scholar
  32. 32.
    Friege B, Friege L, Pelz J et al (2009) Bronchial asthma and chronic obstructive pulmonary disease with acute exacerbation: preclinical differential diagnostic and emergency treatment. Anaesthesist 58(6):611–622PubMedCrossRefGoogle Scholar
  33. 33.
    Fick DM, Semla TP (2012) 2012 American Geriatrics Society Beers Criteria: new year, new criteria, new perspective. J Am Geriatr Soc 60(4):614–615. DOI 10.1111/j.1532-5415.2012.03922.xPubMedCrossRefGoogle Scholar
  34. 34.
    Gallagher P, Ryan C, Byrne S et al (2008) STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther 46(2):72–83PubMedGoogle Scholar
  35. 35.
    Holt S, Schmiedl S, Thürmann PA (2010) Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int 107(31–32):543–551Google Scholar
  36. 36.
    Wehling M (2008) Drug therapy in the elderly: too much or too little, what to do? A new assessment system: fit for the aged (FORTA). Dtsch Med Wochenschr 133(44):2289–2291PubMedCrossRefGoogle Scholar
  37. 37.
    Mann E, Böhmdorfer B, Frühwald T et al (2012) Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list. Wien Klin Wochenschr 124(5–6):160–169Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Abteilung für Innere Medizin und AkutgeriatrieLandeskrankenhaus HochzirlZirlÖsterreich
  2. 2.Abteilung für Akutgeriatrie/RemobilisationLandeskrankenhaus GmundenGmundenÖsterreich

Personalised recommendations