View source for Digoxin immune fab

==Background==
*1 Fab vial binds 0.5mg of digoxin
*Clinical improvement usually seen within 1hr
*May give as IV bolus in cardiac arrest; otherwise give over 30min

==Indications==
*Ventricular dysrhythmias
*Hemodynamically significant [[bradyarrhythmias]] unresponsive to standard therapy
*[[Hyperkalemia]] > 5.5 associated with toxic digoxin level or presumptive diagnosis of overdose
*Also consider for:
**Pacemaker (may mask cardiac dysrhythmia)
**Dig level > 10 in acute ingestion
**Dig level > 4 in chronic ingestion
**If adult acutely ingests > 10mg
**If child acutely ingests > 4mg

==Side Effects==
*Withdrawal of dig effect:
**[[CHF]], A-fib with RVR
*Hypokalemia

==How To Use==
*'''Neither amount ingested nor digoxin level are known:'''
**Adult dose
***10 vials over 30 min; repeat dose if clinical response is inadequate
**Peds dose
***5 vials over 30 min; repeat dose if clinical response is inadequate
*'''Amount ingested is known but digoxin level is unknown'''
**Calculate total body load (TBL)
***TBL = Dose (in mg) ingested x 0.8
**Calculate number of vials needed
***Number of vials = TBL X 2 (round up to nearest whole number)
*'''Steady state digoxin level is known'''
**Number of vials = (dig level (in ng/mL) X patient wt) / 100
*'''Chronic toxicity without severe signs'''
**Give half the recommended dose
***Otherwise may unmask the condition for which the patient is taking digoxin
*'''Cardiac Arrest'''
**20 vials administered undiluted by IV bolus


==Indications by Condition==
''The following table is automatically generated from disease/condition pages across WikEM.''

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==See Also==
*[[Digoxin Toxicity]]

==References==
*2019 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674-694. doi: 10.1111/jgs.15767 [PubMed 30693946]
*Alsaied T, Baskar S, Fares M, et al. First-line antiarrhythmic transplacental treatment for fetal tachyarrhythmia: a systematic review and meta-analysis. J Am Heart Assoc. 2017;6(12). pii: e007164. doi: 10.1161/JAHA.117.007164. [PubMed 29246961]
*Anderson PO, Sauberan JB. Modeling drug passage into human milk. Clin Pharmacol Ther. 2016;100(1):42-52. doi: 10.1002/cpt.377. [PubMed 27060684]10.1002/cpt.377
*Aronoff GR, Bennett WM, Berns JS, et al. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children. 5th ed. Philadelphia, PA: American College of Physicians; 2007:42.
*Azancot-Benisty A, Jacqz-Aigrain E, Guirgis NM, Decrepy A, Oury JF, Blot P. Clinical and pharmacologic study of fetal supraventricular tachyarrhythmias. J Pediatr. 1992;121(4):608-613. [PubMed 1403399]
*Bakir M, Bilgiç A. Single daily dose of digoxin for maintenance therapy of infants and children with cardiac disease: is it reliable? Pediatr Cardiol. 1994;15(5):229-232. [PubMed 7997427]
*Bendayan R, McKenzie MW. Digoxin pharmacokinetics and dosage requirements in pediatric patients. Clin Pharm. 1983;2(3):224-235. [PubMed 6349908]
*Burk O, Brenner SS, Hofmann U, et al. The Impact of Thyroid Disease on the regulation, expression, and function of ABCB1 (MDRa/P-glycoprotein) and consequences for the disposition of digoxin. Clin Pharm Ther. 2010;88(5):685-694. [PubMed 20844484]
*Cheng JW, Rybak I. Use of digoxin for heart failure and atrial fibrillation in elderly patients. Am J Geriatr Pharmacother. 2010;8(5):419-427. [PubMed 21335295]
*Colucci WS, Sylvia L. Use of digoxin in heart failure with reduced ejection fraction. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 22, 2018.

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[[Category:Pharmacology]]
[[Category:Toxicology]]