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. 1978 Jan;40(1):8–13. doi: 10.1136/hrt.40.1.8

Computer-assisted review of digoxin therapy in the elderly.

B Whiting, I Wandless, D J Sumner, A Goldberg
PMCID: PMC481967  PMID: 626668

Abstract

Current practice with digoxin was assessed in a group of 42 elderly patients by comparing plasma digoxin concentrations attained on previously established maintenance doses with those generated by a computer programme designed to calculate dosage schedules to suit individual patients. Discrepancies between measured and computed plasma levels and between established and computed doses dictated withdrawal of the drug or revision of dosage in 26 patients (62%), with obvious clinical benefit. An important determinant of dosage was renal function; reduction in creatinine clearance provided good evidence for the loss of ability of the elderly kidney to eliminate digoxin. Simple bedside methods are available which permit a reliable estimate of creatinine clearance without a 24-hour urine collection, provoding a rational basis for the choice of digoxin dosage in the elderly.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BRICKER N. S., MORRIN P. A., KIME S. W., Jr The pathologic physiology of chronic Bright's disease. An exposition of the "intact nephron hypothesis". Am J Med. 1960 Jan;28:77–98. doi: 10.1016/0002-9343(60)90225-4. [DOI] [PubMed] [Google Scholar]
  2. Dall J. L. Maintenance digoxin in elderly patients. Br Med J. 1970 Jun 20;2(5711):705–706. doi: 10.1136/bmj.2.5711.705. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dobbs S. M., Mawer G. E., Rodgers M., Woodcock B. G., Lucas S. B. Can digoxin dose requirements be predicted? Br J Clin Pharmacol. 1976 Apr;3(2):231–237. doi: 10.1111/j.1365-2125.1976.tb00597.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Huffman D. H., Manion C. V., Azarnoff D. L. Absorption of digoxin from different oral preparations in normal subjects during steady state. Clin Pharmacol Ther. 1974 Aug;16(2):310–317. doi: 10.1002/cpt1974162310. [DOI] [PubMed] [Google Scholar]
  5. Ingelfinger J. A., Goldman P. The serum digitalis concentration--does it diagnose digitalis toxicity? N Engl J Med. 1976 Apr 15;294(16):867–870. doi: 10.1056/NEJM197604152941603. [DOI] [PubMed] [Google Scholar]
  6. Jelliffe R. W., Brooker G. A nomogram for digoxin therapy. Am J Med. 1974 Jul;57(1):63–68. doi: 10.1016/0002-9343(74)90769-4. [DOI] [PubMed] [Google Scholar]
  7. Jelliffe R. W., Buell J., Kalaba R. Reducation of digitalis toxicity by computer-assisted glycoside dosage regimens. Ann Intern Med. 1972 Dec;77(6):891–906. doi: 10.7326/0003-4819-77-6-891. [DOI] [PubMed] [Google Scholar]
  8. Johnson B. F., Bye C. Maximal intestinal absorption of digoxin, and its relation to steady state plasma concentration. Br Heart J. 1975 Feb;37(2):203–208. doi: 10.1136/hrt.37.2.203. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Kampmann J., Siersbaek-Nielsen K., Kristensen M., Hansen J. M. Rapid evaluation of creatinine clearance. Acta Med Scand. 1974 Dec;196(6):517–520. doi: 10.1111/j.0954-6820.1974.tb01053.x. [DOI] [PubMed] [Google Scholar]
  10. Kolendorf K., Christiansen N. J., Siersbaek-Nielsen K., Hansen J. M. Serum-digoxin after dosage regimen based on body-weight and renal function. Lancet. 1972 Aug 12;2(7772):326–326. doi: 10.1016/s0140-6736(72)92926-1. [DOI] [PubMed] [Google Scholar]
  11. Koup J. R., Jusko W. J., Elwood C. M., Kohli R. K. Digoxin pharmacokinetics: role of renal failure in dosage regimen design. Clin Pharmacol Ther. 1975 Jul;18(1):9–21. doi: 10.1002/cpt19751819. [DOI] [PubMed] [Google Scholar]
  12. Mawer G. E. Computer assisted prescribing of drugs. Clin Pharmacokinet. 1976;1(1):67–78. doi: 10.2165/00003088-197601010-00006. [DOI] [PubMed] [Google Scholar]
  13. Peck C. C., Sheiner L. B., Martin C. M., Combs D. T., Melmon K. L. Computer-assisted digoxin therapy. N Engl J Med. 1973 Aug 30;289(9):441–446. doi: 10.1056/NEJM197308302890902. [DOI] [PubMed] [Google Scholar]
  14. Sheiner L. B., Halkin H., Peck C., Rosenberg B., Melmon K. L. Improved computer-assisted digoxin therapy. A method using feedback of measured serum digoxin concentrations. Ann Intern Med. 1975 May;82(5):619–627. doi: 10.7326/0003-4819-82-5-619. [DOI] [PubMed] [Google Scholar]
  15. Sumner D. J., Russell A. J. Digoxin pharmacokinetics: multicompartmental analysis and its clinical implications. Br J Clin Pharmacol. 1976 Apr;3(2):221–229. doi: 10.1111/j.1365-2125.1976.tb00596.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Wagner J. G. Loading and maintenance doses of digoxin in patients with normal renal function and those with severely impaired renal function. J Clin Pharmacol. 1974 Jul;14(7):329–338. doi: 10.1002/j.1552-4604.1974.tb01408.x. [DOI] [PubMed] [Google Scholar]
  17. Wandless I., Davie J. W. Can drug compliance in the elderly be improved? Br Med J. 1977 Feb 5;1(6057):359–361. doi: 10.1136/bmj.1.6057.359. [DOI] [PMC free article] [PubMed] [Google Scholar]

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