DOSIFICACION DE DIGOXINA A PARTIR DE LA FORMULA HUGE

Publicado en Drugs Aging (2016) 33:277–284

A New Method for Individualized Digoxin Dosing in Elderly
PatientsAna Martin-Suarez, David Garcıa Gonzalez, Juan F. Macıas Nunez, Ramon Ardanuy Albajar,  M. Victoria Calvo Hernandez.

Background Digoxin is a frequently prescribed drug in
the elderly population. Estimated glomerular filtration rate
is widely used to adjust dosages. The HUGE value is a tool
for differentiating the presence or absence of chronic kidney

 disease in elderly patients. We aimed to investigate the
usefulness of the HUGE value to predict the initial dose of
digoxin in patients aged older than 70 years.Methods We reviewed retrospectively the medical
records of patients aged older than 70 years with serum
digoxin concentrations (SDCs) monitored over a 6-month
period (63 patients). A linear regression relating the
patient’s SDC, maintenance dose of digoxin and the HUGE
value was estimated to generate a dosage equation. This
equation was validated retrospectively (33 patients) and
prospectively (35 patients) in comparison with two existing
methods based on creatinine clearance.Results An equation (HUGE_DIG) was generated to
calculate the initial digoxin dose to reach a specific target
SDC. Thus, to achieve a SDC of 0.8 ng/mL:
Digoxin (mg/day) = 0.091-0.006*HUGE

 After retrospective validation, the calculated digoxin doses with this
equation were administered in the prospective phase and
we did not observe statistical differences between measured and desired SDCs. Moreover, the predictive performance of our equation was better than that obtained with
the compared methods.Conclusions We offer a new validated digoxin dosing
equation for elderly patients. Our results support the need
to perform digoxin dosing in elderly people, bearing in
mind the changes in renal physiology secondary to ageing
and not merely the estimated glomerular filtration rate.