Tips from the creator:
Why to Use
Digoxin immune Fab (DigiFab®, Digibind®) is an effective antidote for acute, acute on chronic, and chronic digoxin toxicity. It is also indicated for poisoning from other cardioactive steroids.
When to Use
General Indications
Specific Indications
Next Steps
The DigiFab® dosing tool is intended to assist with dose calculation for digoxin immune Fab, and does not provide comprehensive or definitive drug information. Always check dosing of any drug and consult a pharmacist when necessary.
Scott Lucyk, MD
Frequent premature ventricular complexes may be closely followed by ventricular dysrhythmias.
Potassium abnormalities, specifically hypokalemia, may worsen digoxin toxicity, even at therapeutic digoxin levels. If hyperkalemia is mild, correction is not advised, as treatment with digoxin immune Fab will decrease potassium concentrations. Treatment to lower serum potassium concentrations should be performed prior to digoxin immune Fab administration only if (1) hyperkalemia is believed to be worsening atrioventricular nodal block and bradycardia, and (2) digoxin immune Fab is not immediately available. If hypokalemia is present, cautious correction should be performed prior to the administration of digoxin immune Fab. If there is worsening toxicity/dysrhythmia, or if toxicity does not improve with correction of hypokalemia, digoxin immune Fab should be immediately administered. Do not administer calcium salts to patients with hyperkalemia secondary to digoxin toxicity. Transcutaneous and especially transvenous pacing should be avoided in patients with digoxin toxicity due to risk for precipitating dysrhythmias.
The therapeutic range for serum digoxin level is 0.8 to 2.0 ng/mL (1.0-2.6 nmol/L). In the case of acute poisoning with serum digoxin level confirmed at > 10 ng/mL, an empiric dose (10-20 vials) should be administered. Additional considerations for treatment of digoxin toxicity include:
The relationship between serum potassium concentrations and mortality in patients treated for digitoxin toxicity was investigated at the Fernand Widal Toxicology Center in Paris between 1967 and 1972.
Among patients with digitoxin toxicity, the majority of whom (81 of 91 patients) took digitoxin with suicidal intent, all patients with an initial serum potassium level > 5.5 mEq/L died, whereas all patients with an initial serum potassium level < 5 mEq/L survived (Bismuth 1973).
In 1990, Antman et al conducted a nationwide, prospective, open-label, multicenter clinical trial of 148 patients with potentially life-threatening digitalis intoxication who were treated with purified digoxin-specific Fab fragments. Resolution of all signs and symptoms of digitalis toxicity occurred in 119 patients (80%), 14 patients (9%) showed improvement, and 15 patients (10%) showed no response, though this group included moribund patients and patients who were retrospectively believed to not be suffering from digitalis toxicity. Among the 56 patients with cardiac arrest who were treated with Fab fragments, 30 patients (54%) survived hospitalization.
Frédéric Lapostolle, MD
Original/Primary Reference
Addition References
Wesley Palatnick, MD, FRCPC, FACMT; Tomislav Jelic, MD, FRCPC, FACEP
Karan Pratap Singh, MD, MBA, FAAEM
September 15, 2020
September 15, 2023   CME Information
4 AMA PRA Category 1 Credits.™ Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Pharmacology CME credits, subject to your state and institutional approval.
Price: $99
+4 Credits!
Wesley Palatnick, MD, FRCPC, FACMT; Tomislav Jelic, MD, FRCPC, FACEP
Karan Pratap Singh, MD, MBA, FAAEM
September 15, 2020
September 15, 2023
4 AMA PRA Category 1 Credits.™ Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Pharmacology CME credits, subject to your state and institutional approval.
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