IV Digoxin Loading Dose: SVT in Elderly Patients

• No specific guidance on the dose (normal dose: 0.5 – 1mg)¹
• Consideration in elderly patients^2,3:
• Reduced volume of distribution
• Reduced renal excretion
• Thus, loading dose needs to be reduced. There is one reference that recommends that the dose be reduced by up to 50% in elderly patients³
• Recommendation:
• Loading dose should be around 0.5 – 0.75mg
• Administer 50% initially; then may cautiously give 1/4 the loading dose q6-8hr twice; perform careful assessment of clinical response and toxicity before each dose

 References:

1. Lexi-Comp Version 1.9.2
2. Currie GM, Wheat JM, Kiat H. Pharmacokinetic Considerations for Digoxin in Older People.Open Cardiovasc Med J. 2011; 5: 130–135. Published online 2011 Jun 15. doi:  10.2174/1874192401105010130
3. CANTERBURY DISTRICT HEALTH BOARD. Pharmacy Services Update DIGOXIN DOSING. Bulletin No: 2007/1