UMEM Educational Pearls

Category: Toxicology

Title: Does Digoxin Immune Fab Work in Chronic Digoxin Poisoning?

Keywords: digoxin, chronic, poisoning, immune Fab (PubMed Search)

Posted: 5/9/2016 by Bryan Hayes, PharmD (Emailed: 5/12/2016) (Updated: 5/12/2016)
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Patients with chronic digoxin toxicity generally have multiple co-morbidities such as renal failure, dehydration, and cardiac failure. Sick patients with chronically high digoxin levels may have more than just digoxin toxicity as the cause of illness.

A New Study

Prospective observational study with the primary objective to investigate changes in free digoxin concentrations and clinical effects on heart rate and potassium concentrations in chronic digoxin poisoning when digoxin immune Fab are given.

What They Found

One to two vials of digoxin immune Fab initially bound all free digoxin confirming Fab efficacy. However, this was associated with only a moderate improvement in HR (49 to 57 bpm) and potassium (5.3 to 5.0 mmol/L).

Application to Clinical Practice

  • Elevated digoxin concentrations alone may not be solely responsible for bradycardia and hyperkalemia in the chronic setting.
  • Digoxin immune Fab is not a magic bullet in chronic digoxin poisoning.


Chan BS, et al. Efficacy and effectiveness of anti-digoxin antibodies in chronic digoxin poisonings from the DORA study (ATOM-1). Clin Toxicol. 2016 Apr 27. Epub ahead of print. [PMID 27118413]

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