Use of digoxin in older patients

In the treatment of worsening of systolic heart failure important role maintains digoxin. In the management of older patients it is important to take into account age-related changes of pharmacokinetics and pharmacodynamics, decreased glomerular filtration rate, sex and concomitant diseases. Older individuals have lower tolerance of digitalis than younger. They have increased risk of digitalis toxicity. Digitalis Investigation Group clinical study has proven that in patients aged 65 years and older only small serum digoxin concentration (0.5–0.9 ng/ mL) is related to reduce in all cause mortality. The recommended daily dose of digoxin for these patients is 0.125 mg per day. Digoxin could be administered to all patients with heavy heart failure and decreased systolic function together with ACE inhibitors, beta blockers, spironoilactone, diuretics. Thus, the role of digoxin in treatment of heart failure remains secondary.