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A New Method for Individualized Digoxin Dosing in Elderly Patients

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Abstract

Background

Digoxin is a frequently prescribed drug in the elderly population. Estimated glomerular filtration rate is widely used to adjust dosages. The HUGE value is a tool for differentiating the presence or absence of chronic kidney disease in elderly patients. We aimed to investigate the usefulness of the HUGE value to predict the initial dose of digoxin in patients aged older than 70 years.

Methods

We reviewed retrospectively the medical records of patients aged older than 70 years with serum digoxin concentrations (SDCs) monitored over a 6-month period (63 patients). A linear regression relating the patient’s SDC, maintenance dose of digoxin and the HUGE value was estimated to generate a dosage equation. This equation was validated retrospectively (33 patients) and prospectively (35 patients) in comparison with two existing methods based on creatinine clearance.

Results

An equation (HUGE_DIG) was generated to calculate the initial digoxin dose to reach a specific target SDC. Thus, to achieve a SDC of 0.8 ng/mL: \( {\text{Digoxin }}\left( {\frac{\text{mg}}{\text{day}}} \right) = 0.091 - 0.006 \times {\text{HUGE}} \). After retrospective validation, the calculated digoxin doses with this equation were administered in the prospective phase and we did not observe statistical differences between measured and desired SDCs. Moreover, the predictive performance of our equation was better than that obtained with the compared methods.

Conclusions

We offer a new validated digoxin dosing equation for elderly patients. Our results support the need to perform digoxin dosing in elderly people, bearing in mind the changes in renal physiology secondary to ageing and not merely the estimated glomerular filtration rate.

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Authors and Affiliations

  1. Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Salamanca, Salamanca, Spain

    Ana Martin-Suarez & M. Victoria Calvo Hernández

  2. Pharmacy Services, University Hospital of Salamanca, Salamanca, Spain

    David García González & M. Victoria Calvo Hernández

  3. Nefrology Services, University Hospital of Salamanca, Salamanca, Spain

    Juan F. Macías Núñez

  4. Department of Statistics, Faculty of Sciences, University of Salamanca, Salamanca, Spain

    Ramón Ardanuy Albajar

  5. Instituto de Investigación Biomédica de Salamanca, University Hospital of Salamanca, Salamanca, Spain

    Ana Martin-Suarez, Juan F. Macías Núñez & M. Victoria Calvo Hernández

Authors
  1. Ana Martin-Suarez
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  2. David García González
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  3. Juan F. Macías Núñez
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  4. Ramón Ardanuy Albajar
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  5. M. Victoria Calvo Hernández
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Corresponding author

Correspondence to M. Victoria Calvo Hernández.

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Funding

No external funding was used in the conduct of this study.

Conflict of interest

Ana Martin-Suarez, David García González, Juan F. Macías Núñez, Ramón Ardanuy Albajar and M. Victoria Calvo Hernández have no potential conflicts of interest that might be relevant to this manuscript.

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Martin-Suarez, A., García González, D., Macías Núñez, J.F. et al. A New Method for Individualized Digoxin Dosing in Elderly Patients. Drugs Aging 33, 277–284 (2016). https://doi.org/10.1007/s40266-016-0346-5

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  • DOI: https://doi.org/10.1007/s40266-016-0346-5

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