In acute poisoning, a small bolus of 80 mg, repeat if necessary, titrated against clinical effect, is likely to achieve equivalent benefits with much lower total doses.
#Digoxin antidote full#
However, calculated full neutralising doses of digoxin-Fab are expensive and may not be required. In general, 40-120 mg (1-3 vials) should be sufficient.ĭigoxin-Fab is safe and indicated in all patients with life-threatening arrhythmias and an elevated digoxin concentration. In practice, it is suggested to give 40 mg (1 vial) digoxin-Fab at a time and repeat after 60 min if patient is still symptomatic, sooner if patient is clinically unstable. Adverse events such as exacerbation of heart failure, increased ventricular rate and hypokalaemia are uncommon ( 6 h), excessive neutralisation doses may still be calculated because of variation in Vd due to equations failing to account for lean body weight, age and renal failure. The lowest effective digoxin-Fab dosing regimen has not been established. Patients who have life-threatening tachy-bradyarrhythmias, hyperkalaemia (> 6 mmol/L) or haemodynamic instability with an elevated digoxin concentration (> 2 μg/L or 2.6 nmol/L). It has also been proposed to use half this dose. It is sometimes recommended to use full neutralisation doses (based on serum concentration × Vd or ingested dose). Digoxin-Fab was used more frequently in acute than chronic digoxin poisoning with a higher reported success rate when used in acute overdose.
#Digoxin antidote free#
Studies with pharmacokinetic data showed that free digoxin concentration fell to almost zero within a few minutes following the administration of digoxin-Fab. The time for reversal of digoxin toxicity is reported to be 30-45 min.
#Digoxin antidote series#
In three large case series of 430 acute and 1308 chronic poisonings, response rates to digoxin-Fab vary from 80-90% to 50%. Ten case series with a total of 2,080 patients have reported on the use of digoxin-Fab in digoxin poisoning.
There were no randomised clinical trials examining the use of digoxin-Fab for acute or chronic digoxin poisonings. Efficacy and effectiveness of digoxin-Fab. The half-lives of both digoxin and digoxin-Fab are prolonged in renal failure to over 100 h. Digoxin-Fab has a mean plasma half-life of 19-30 h and a Vd of 0.4 L/kg. A 40-mg vial of digoxin-Fab (DigiFab) binds 0.5 mg digoxin. Digoxin has 60-80% bioavailability, a mean plasma half-life of 40 h and a volume of distribution (Vd) of 5-10 L/kg and low protein binding (20%).
Digoxin acts via inhibition of Na⁺/K⁺ ATPase. Pharmacology and kinetics of digoxin and digoxin-Fab. Pubmed, Embase, Medline and Cochrane were searched from 1946 to May 2013 using the terms digoxin, digoxin-specific Fab, and digoxin antibody. To review the pharmacology, efficacy, effectiveness, indications, safety and the dosage of digoxin-specific antibody fragments. Calculated equimolar doses of digoxin-Fab are high, very expensive, and infrequently used. Digoxin-specific antibody fragments (digoxin-Fab) are widely regarded as a safe and effective treatment for the management of acute and chronic digoxin poisoning.
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