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

1. Ventricular dysrhythmias
2. Hemodynamically significant bradyarrhythmias unresponsive to standard therapy
3. Hyperkalemia > 5.5 a/w toxic digoxin level or presumptive diagnosis of overdose
4. Also consider for:
   1. Pacemaker (may mask cardiac dysrhythmia)
   2. Dig level > 10 in acute ingestion
   3. Dig level > 4 in chronic ingestion
   4. If adult acutely ingests > 10mg
   5. If child acutely ingests > 4mg

Side Effects

1. Withdrawal of dig effect:
   1. CHF, A-fib w/ RVR
2. Hypokalemia

How To Use

1. Neither amount ingested nor digoxin level are known:
   1. Adult dose
      1. 10 vials over 30 min; repeat dose if clinical response is inadequate
   2. Peds dose
      1. 5 vials over 30 min; repeat dose if clinical response is inadequate
2. Amount ingested is known but digoxin level is unknown
   1. Calculate total body load (TBL)
      1. TBL = Dose (in mg) ingested x 0.8
   2. Calculate number of vials needed
      1. Number of vials = TBL X 2 (round up to nearest whole number)
3. Steady state digoxin level is known
   1. Number of vials = (dig level(in ng/mL) X pt wt) / 100
4. Chronic toxicity without severe signs
   1. Give half the recommended dose
      1. Otherwise may unmask the condition for which the pt is taking digoxin
5. Cardiac Arrest
   1. 20 vials administered undiluted by IV bolus

See Also

Digoxin Toxicity