Specific toxicology treatments and antidotes: digoxin-specific antibodies
| Specific toxicology treatments and antidotes: digoxin-specific antibodies |
Digoxin-specific antibodies are immunoglobulin (Fab) fragments, derived from sheep proteins that have very high affinity for digoxin in the intravascular space and interstitium. Removing free digoxin from the circulation creates a concentration gradient such that tissue bound digoxin moves back into the intravascular circulation. Digoxin-bound complexes are inactive and are renally excreted.
One vial, containing approximately 40 mg of antibody, binds approximately 500 micrograms of digoxin. The dose may be determined empirically, if a plasma digoxin concentration is unavailable. Generally smaller doses are needed for chronic digoxin toxicity.
Digoxin-specific antibodies are best administered by intravenous infusion over at least 30 minutes. In situations of cardiac arrest, doses may be administered more rapidly, but the risk of allergic reactions may be increased.
Other potential adverse effects are hypokalaemia and exacerbation of congestive heart failure. Plasma digoxin concentrations will remain elevated after administration of the antibodies unless free digoxin concentrations can be measured separately (not widely available).
These antibodies are also effective for other cardiac glycoside poisonings such as oleander and bufotoxin (cane toad).
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