8/13/2023 0 Comments Digoxin antidote![]() This program standardizes treatment for digoxin poisoned patients across the province, resulting in optimal care and reduced costs. DPIC then couriers replacement Digibind® to the treating hospital. Physicians call DPIC for a consultation with a medical toxicologist and, if Digibind® is required, an appropriate dose is released via the hospital pharmacy. Since the early 1990's the BC Drug & Poison Information Centre (DPIC) has offered an antidote replacement program for Digbind®. The average dose for most patients presenting with chronic digoxin toxicity is 2 to 3 vials at a cost of $460.84 per vial. Doses are typically calculated using a post-distributional serum digoxin level and the patient's weight. The digoxin-Fab complexes are then excreted by the kidneys over a period of days. Following intravenous administration, the Fabs rapidly form stable complexes with unbound digoxin in blood and interstitial fluid, essentially inactivating the drug. ![]() The resulting immune response produces digoxin-specific antigen binding fragments (Fabs), which are isolated and formulated into a sterile powder for injection. It is prepared by immunizing sheep with a digoxin analogue coupled to an immunogenic protein. Symptoms of digoxin toxicity include visual disturbances, gastrointestinal symptoms, ataxia, weakness, hyperkalemia, bradycardia, and atrial or ventricular dysrhythmias.(4) Chronic digoxin toxicity can be insidious and life threatening.ĭigoxin immune Fab (Digibind®) is an effective antidote for digoxin toxicity. Elderly patients with acute kidney injury often experience a combination of these factors. In addition, older people have a decreased thirst drive which may lead to dehydration and pre-renal azotemia that is further exacerbated by any intercurrent illness associated with reduced oral intake. Older patients have decreased renal reserve and often take medications such as ACE inhibitors, NSAIDS, or diuretics which may adversely alter renal function. The cause of acute kidney injury in this population is usually multifactoral and the onset is unpredictable. Serum levels of approximately 1.3 nmol/L are recommended for optimal benefit in heart failure.(3)ĭigoxin is eliminated by the kidneys and chronic toxicity typically occurs in elderly patients who develop an acute decline in renal function while taking prescribed doses. He recovered uneventfully.ĭigoxin is commonly prescribed in the elderly for management of atrial fibrillation and heart failure at doses between 0.0625 mg and 0.25 mg once daily.(1) After absorption digoxin is widely distributed in tissues with a distribution phase of approximately 6 to 8 hours.(2) Digoxin has a narrow therapeutic window with post distributional therapeutic serum concentrations ranging from 0.5 to 2.5 nmol/L. The patient was treated with intravenous fluids and 6 vials of Digibind® antidote. The patient appeared dehydrated with a heart rate of 30 beats per minute and an ECG showing third degree heart block. His labwork showed a post-distributional serum digoxin level of 6.1 nmol/L (normal: 0.5 to 2.5), serum creatinine of 385 µmol/L (estimated GFR 26 mL/min normal: 75-125), blood urea nitrogen of 26 mmol/L (normal: 2.5-8.0) and a serum potassium of 7.4 mmol/L (normal: 3.5-5.0). Other medications included furosemide, metoprolol, ramipril, clopidogrel, ASA, and insulin. For the past 3 years he had been receiving digoxin 0.25 mg daily for heart failure. His family reported that he had the "flu" for the last week with poor appetite and weakness. A 76-year-old, 120 kg diabetic male presented to the emergency department with confusion and dizziness.
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