Geriatric Quick Consult      Medications to Avoid in the Elderly      Don't #8

Don't prescribe high doses of digoxin (>0.125 mg/day) for elderly patients except when treating atrial arrhythmias.

Knowledge Action

Digoxin (Lanoxin®) is prescribed in the elderly to treat common cardiac diseases including atrial fibrillation and heart failure.

The elderly are at increased risk of toxicity due to age-related and disease-related changes in physiology.

The half-life of digoxin is prolonged in the elderly.

Changes in dosing are required because of declining renal function with age.

Serum levels of digoxin may not be a good indicator of potential for toxicity.

Signs of toxicity in the elderly include heart block, cardiac arrhythmias, anorexia, vision changes (blurred), confusion and depression.

Elderly patients on digoxin require vigilant monitoring for adverse effects.

  • Monitor patients on digoxin vigilantly for adverse effects.
If using digoxin, measure digoxin levels, and target the range of 0.5 to 1.0 ng/DL.

When treating atrial fibrillation, rate control is the goal, and higher digoxin levels are sometimes needed. However, side effects are common.

Other drugs (diltiazem, beta blockers) are often effective for rate control, so reliance on digoxin is no longer necessary in most such cases.

When possible, use other drugs, like diltiazem or beta blockers for rate control to avoid digoxin side effects.



(Semla TP, Beizer JL, Higbee MD. Geriatric Dosage Handbook, 8th edition. Hudson (Cleveland): Lexi-Comp Inc., 2003.)
  • When treating atrial fibrillation, rate control is the goal.


  • When possible, use other drugs for rate control to avoid digoxin side effects.
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