Digoxin dosing in the aged: new pharmacokinetic system versus Jellife and Koup methods

To evaluate three methods for digoxin dose adjustment in aged patients, we determined the plasma digoxin levels that would be attained in 87 aged patients with doses adjusted to the kidney function by means of three separate procedures. Mean patient age was: 79.0 +/- 6.3 years; creatinine clearance (Clc): 0.70 +/- 0.23 mL/Kg of lean body weight and minute; digoxinemia/dose ratio (RCpD): 0.421 +/- 0.237 Kg/L. The dose that would attain a digoxinemia of 1.2 ng/mL, calculating the elimination constant (K) and the volume of distribution (V) as linear functions of the Clc, so that K ranges between 0.173 and 0.462 days-1 and V between 4 and 10 L/Kg of lean body weight when the Clc varies from 0 to 110 mL/minute, was 2947 ng/Kg of lean body weight, coefficient of variation (CV): 25.2%. The digoxinemia that patients would have with this D, taking into account the individual RCpD, was 1.1 ng/mL, CV: 38.0%; with figures between 0.8 y 2.0 ng/mL and above 2.0 ng/mL in the 81.6% and the 0.0% of the patients (95% confidence intervals (95% CI): 72.2% to 88.4 and 0.0% to 4.6%), respectively. The precision and the bias were 0.43 and -0.06 ng/mL (95% CI: 0.38 to 0.48 and -0.16 to 0.03 ng/mL), respectively, and with this method the digoxinemia was not associated with the Clc. We concluded that the described method would lead to good results if digoxin has not been prescribed in order to control the cardiac frequency in the setting of auricular fibrilation.