Regularly monitor serum digoxin levels. Target therapeutic levels are generally lower in older adults, typically 0.5-0.8 ng/mL, although this can vary based on individual patient response. Frequent monitoring, especially during initiation and dosage adjustments, is critical.
Factors Influencing Digoxin Levels
Consider age-related physiological changes. Reduced renal function is common, impacting digoxin excretion. Decreased lean body mass alters digoxin distribution. Concurrent medications, such as diuretics or antibiotics, can significantly influence digoxin levels through interactions. Always carefully review a patient’s medication history.
Adjust dosage cautiously. Start with a lower initial dose, typically 0.125 mg daily, and increase slowly, monitoring serum levels closely after each adjustment. Smaller, more frequent dose adjustments are usually safer than large infrequent ones. Be particularly mindful of potential drug interactions. Consider using digoxin-specific antibody fragments (Digibind) in case of digoxin toxicity.
Responding to Changes
Monitor for signs of digoxin toxicity: nausea, vomiting, anorexia, visual disturbances, arrhythmias. Immediately reduce or discontinue digoxin if toxicity is suspected. Document all changes to the dosage and the reasons for those changes. Closely monitor the patient for any adverse effects.
Regularly reassess the need for digoxin therapy. Assess the patient’s overall clinical status and adjust treatment accordingly. Digoxin may no longer be needed as the patient’s condition improves.
