Comparing the toxicity of digoxin and digitoxin in a geriatric population:Should an old drug be rediscovered?

Background. Little information is available regarding toxicity rates of the two available forms of cardiac glycosides (digoxin, digitoxin) when used i n elderly patients. Methods. We retrospectively analyzed the charts of all patients more than 6 0 years of age who were chronically managed with a cardiac glycoside and we re hospitalized during the period January 1995 through January 1998. Toxici ty was defined as any clinical event that required either a reduction in do se of the drug or its discontinuance. Results. Toxicity occurred among 7.6% of hospitalizations in which digitoxi n was used, compared with 18.3% of hospitalizations in which digoxin was us ed. In multivariate analysis, the odds of toxicity adjusted for other clini cal characteristics were three times greater for patients taking digoxin th an for patients taking digitoxin. Conclusion. Hospitalized elderly patients taking digitoxin had a lower rate of toxicity than those taking digoxin.