Increased risk of digoxin toxicity following hospitalization
ABSTRACT PurposeAdverse drug events (ADEs) are an important cause of preventable hospitalizations among elderly individuals taking high-risk medications. The objective of the study was to identify health care system factors that affect the risk of digoxin toxicity for older adults on digoxin.Methods
We conducted a prospective cohort study of older adults within the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) program, which provides comprehensive drug benefits for older adults with low income. Subjects were interviewed at the time of enrollment regarding the management and coordination of their health care as well as medication comprehension. Hospitalizations were identified by linking patient identifiers to a state-wide registry. Trained abstractors reviewed discharge summaries of possible digoxin related ADEs. Unadjusted and adjusted incidence rate ratios (IRR) were calculated based on person–months of exposure using Poisson regression models, with variances adjusted for within subject repeated measures.ResultsWe enrolled a total of 2030 adults on digoxin from May 2002 to June 2003. A total of 34 hospitalizations due to digoxin toxicity occurred, equivalent to 1.12 hospitalizations per 1000 person–months of exposure. Adjusting for hospitalization in the past 2 months, age, total number physicians prescribing any medications in past 3 months, total number of pharmacies filling medications in past 3 months, and number of unique prescriptions filled in the past month had a 4.25-fold increased risk of subsequently experiencing digoxin toxicity (IRR 95%CI 1.95, 9.27).Conclusions
The risk of digoxin toxicity-related hospitalization, while low, is higher in the post-hospital period. Copyright © 2008 John Wiley & Sons, Ltd.
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- "In the presence of hypokalemia, digoxin can exacerbate the development of life-threatening ventricular arrhythmias. Due to reduced renal function, elderly patients are more susceptible to developing digitalis toxicity., Class I antiarrhythmic drugs in patients with coronary artery disease and myocardial infarction are pro-arrhythmic and may cause sudden death., "
ABSTRACT: Human aging is a global issue with important implications for current and future incidence and prevalence of health conditions and disability. Cardiac arrhythmias, including atrial fibrillation, sudden cardiac death, and bradycardia requiring pacemaker placement, all increase exponentially after the age of 60. It is important to distinguish between the normal, physiological consequences of aging on cardiac electrophysiology and the abnormal, pathological alterations. The age-related cardiac changes include ventricular hypertrophy, senile amyloidosis, cardiac valvular degenerative changes and annular calcification, fibrous infiltration of the conduction system, and loss of natural pacemaker cells and these changes could have a profound effect on the development of arrhythmias. The age-related cardiac electrophysiological changes include up- and down-regulation of specific ion channel expression and intracellular Ca(2+) overload which promote the development of cardiac arrhythmias. As ion channels are the substrates of antiarrhythmic drugs, it follows that the pharmacokinetics and pharmacodynamics of these drugs will also change with age. Aging alters the absorption, distribution, metabolism, and elimination of antiarrhythmic drugs, so liver and kidney function must be monitored to avoid potential adverse drug effects, and antiarrhythmic dosing may need to be adjusted for age. Elderly patients are also more susceptible to the side effects of many antiarrhythmics, including bradycardia, orthostatic hypotension, urinary retention, and falls. Moreover, the choice of antiarrhythmic drugs in the elderly patient is frequently complicated by the presence of co-morbid conditions and by polypharmacy, and the astute physician must pay careful attention to potential drug-drug interactions. Finally, it is important to remember that the use of antiarrhythmic drugs in elderly patients must be individualized and tailored to each patient's physiology, disease processes, and medication regimen.Journal of Geriatric Cardiology 09/2011; 8(3):184-94. DOI:10.3724/SP.J.1263.2011.00184 · 1.40 Impact Factor
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ABSTRACT: agents administered during hospi- talization at a tertiary care acade- mic medical center. The retrospec- tive analysis was conducted over 1 year. A total of 416 allergies were reported among 300 patients; more than 1 allergy was reported by more than one-fourth of study patients (82/300 (27.3%)). Only 36.3% (151/416) of allergies reported were accompanied by a reaction description (95% confi- dence interval (CI), 31.7% to
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ABSTRACT: MEDICATION SAFETY Overlooked Renal Dosage Adjustments A retrospective analysis of 647 patients at hospital discharge com-pared required renal dosage adjust-ments to dosage actually prescribed. This study was conducted at VieCuri Medical Centre in Venlo, Netherlands. Patient demographics and renal function data were col-lected, and dosage adjustment needs were assessed via the pharmacy-supported discharge counseling ser-vice. The incidence of inappropriate dosing based on renal function was measured at hospital discharge. Thirty-seven percent of patients evaluated during the study period (237/647) had a creatinine clear-ance less than 51 mL/min/1.73 m 2 ; dosage adjustment was warranted in 23.9% (411/1,718) of prescrip-tions. When dosage adjustment should have been performed, more than 40% of prescriptions (169/411; 41.1%) were inappropri-ate for renal function (9.8% of pre-scriptions overall; 169/1,718). Fur-thermore, 60.4% (102/169) of inappropriate prescriptions pos-sessed the potential for moderate or severe clinical consequences, as evaluated by a panel of two clinical pharmacologists and one nephrolo-gist. Study authors also noted a lack of standardized dosing guidelines for agents requiring renal dosage adjustment. The authors also sug-gested that augmenting medication systems by adding dynamic renal dosing alerts would improve moni-toring. Summary: A comparison of suggested renal dosing and actual dosing at hospital discharge revealed that appropriate prescribing may be overlooked. van Dijk EA, Drabbe NRG, Kruijtbosch M, De Smet PAGM. Drug dosage adjust-ments according to renal function at hos-pital discharge. Ann Pharmacother. 2006;40:1254-1260.Hospital pharmacy 12/1122; 41(7). DOI:10.1310/hpj4311-937