Digoxin treatment and control in the elderly.

The efficacy and the risk of toxicity of long-term digoxin therapy were assessed in 81 elderly patients. The findings show that the serum digoxin level did not correlate with the clinical state. Only 47% of the patients were on a dosage considered to be effective by serum digoxin analysis, whereas 38% of the patients had levels below the therapeutic range; 51% of the patients had been treated with pediatric or semipediatric doses only. Electrocardiographic evidence of digoxin toxicity was found in 17%. Routine periodic measurement of serum digoxin did not correlate with better management. The optimum dosage of digoxin in the elderly patient who is not in overt renal failure and who is not particularly underweight would seem to be 0.19 mg/day, i.e., one and one-half tablets of 0.25 mg on alternate days.