digoxin and Hypotension--Orthostatic

Syncope due to orthostatic hypotension (OH) refers to loss of consciousness caused by hypotension induced by the upright position; it is an important risk factor for fall-related physical injuries, especially in the elderly adults. We evaluated the prevalence of OH syncope and the clinical characteristics of patients older than 65 years with syncope due to OH in the Evaluation of Guidelines in Syncope Study 2 group population.. Two hundred fifty nine patients older than 65 years consecutively admitted to the emergency department because of loss of consciousness in a period of a month were submitted to a standardized protocol approved by the European Task Force for the diagnosis of syncope; all the patients were studied by a trained physician who interacted with a central supervisor as the management of syncope was concerned, using a decision-making software.. Prevalence of OH syncope was 12.4%. Patients with OH syncope were more likely to be affected by Parkinson's disease and by other neurological diseases. ST changes and longer values of QTc were found in OH syncope group, and they took a greater number of diuretics, nitrates, and digoxin. In multivariate analysis, Parkinson's disease (p = .001) and use of nitrates (p = .001) and diuretics (p = .020) were independently related to OH syncope.. In patients older than 65 years, Parkinson's disease and neurological comorbidity are strictly related to OH syncope. Moreover, this study suggests the independent link between OH syncope and the use of vasoactive drugs, identifying the majority of cases as adverse drug reaction, a preventable risk factor for syncope and falls in the older population.

Topics: Accidental Falls; Aged; Aged, 80 and over; Digoxin; Diuretics; Electrocardiography; Emergency Service, Hospital; Female; Humans; Hypotension, Orthostatic; Italy; Male; Nitrates; Parkinson Disease; Practice Guidelines as Topic; Prevalence; Prospective Studies; Risk Factors; Syncope, Vasovagal

Two women, aged 77 and 73 years, and one man, aged 71 years, were admitted because of a serious adverse drug reaction (ADR). The first woman had a probable adverse drug reaction caused by digoxin after the addition of a NSAID (diclofenac) to a combination of digoxin and other drugs (furosemide and hydroquinine). The ADR due to digoxin is an example of a pharmacokinetic interaction. The second woman had serious orthostatic hypotension because of a pharmacodynamic interaction between three different antihypertensives. In the man, the ADR was hypoglycaemia while taking glibenclamide, a second generation sulfonylurea derivative. This was probably caused by declining renal function of a transplanted kidney because of bladder cancer. Doctors should be aware of ADRs in older patients, which also can occur when no changes in medication have taken place. In old age, any decline in vitality or function can be due to an ADR.

Topics: Adverse Drug Reaction Reporting Systems; Aged; Anti-Arrhythmia Agents; Anti-Inflammatory Agents, Non-Steroidal; Antihypertensive Agents; Diclofenac; Digoxin; Diuretics; Drug Interactions; Female; Furosemide; Glyburide; Humans; Hypoglycemia; Hypoglycemic Agents; Hypotension, Orthostatic; Kidney; Male; Quinidine; Urinary Bladder Neoplasms

Topics: Aged; Arrhythmias, Cardiac; Bethanidine; Digoxin; Drug-Related Side Effects and Adverse Reactions; Female; Furosemide; Humans; Hyperkalemia; Hypotension, Orthostatic; Male; Middle Aged; Spironolactone; Uremia

Topics: Aged; Digoxin; Dihydroxyphenylalanine; Drug Prescriptions; Drug Therapy; Drug Tolerance; Female; Geriatrics; Humans; Hypotension, Orthostatic; Male; Pharmaceutical Preparations