UMEM Educational Pearls

Category: Toxicology

Title: A Simpler Dosing Scheme for Digoxin-Specific Antibody Fragments

Keywords: digoxin, digoxin-specific antibody fragments, digoxin-Fab (PubMed Search)

Posted: 9/9/2014 by Bryan Hayes, PharmD (Emailed: 9/11/2014) (Updated: 9/11/2014)
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Digoxin-specific antibody fragments (Fab) are safe and indicated in all patients with life-threatening dysrhythmias and an elevated digoxin concentration. However, full neutralizing doses of digoxin-Fab are expensive and may not be required (not to mention cumbersome to calculate).

Based on pharmacokinetic modeling and published data, a new review suggests a simpler, more stream-lined dosing scheme as follows:

  • In imminent cardiac arrest, it may be justified to give a full neutralizing dose of digoxin-Fab.

  • In acute poisoning, a bolus of 80 mg (2 vials), repeat if necessary, titrated against clinical effect, is likely to achieve equivalent benefits with much lower total doses.

  • With chronic poisoning, it may be simplest to give 40 mg (1 vial) at a time and repeat after 60 min if there is no response.


Chan BS, et al. Digoxin-specific antibody fragments in the treatment of digoxin toxicity. Clin Toxicol 2014;52:824-36. [PMID 25089630]

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