[Glycoside therapy in elderly patients (author's transl)].

Despite decreasing renal function with increasing age, an elevated level of serum glycoside concentration is not noted in elderly patients after undergoing continuous therapy with 0,2 or 0,3 mg beta-methyldigoxin, 0,4 mg beta-acetyldigoxin or 0,5 mg digoxin respectively, as long as the serum creatinine is still normal. Therefore, it is sufficient to determine the serum creatinine level before initiating glycoside therapy with digoxin or digoxin derivates. As a rule, a continuous oral therapy using 0,2 mg beta-methyldigoxin, 0,3 mg beta-acetyldigoxin or 0,375 mg digoxin can be carried out on elderly patients having a normal serum creatinine level, without risk and without danger of toxic side-effects. There is evidence that glycoside tolerance is decreased in the elderly. In elderly patients with a serum concentration level of 2,3 ng/ml or higher, 87% showed toxic side-effects, whereas in the younger age group only 72% of the patients with equally high serum glycoside concentrations were intoxicated. Therefore, oral doses exceeding 0,2 mg beta-methyl-digoxin, 0,3 mg beta-acetyldigoxin, or 0,375 mg digoxin should be carefully controlled by EKG in elderly patients. The most frequent cause of intoxication in elderly patients (75% of the cases) was an impaired renal function with elevation of the serum creatinine level,--a factor which was not taken into consideration in determining the glycoside dosage.