Digoxin immune fab
(Redirected from 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
- Adult dose
- 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)
- Calculate total body load (TBL)
- 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
- Give half the recommended dose
- Cardiac Arrest
- 20 vials administered undiluted by IV bolus
See Also
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]
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- 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
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- 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.