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VARIOUS › ALL OTHER THERAPEUTIC PRODUCTS › ALL OTHER THERAPEUTIC PRODUCTS › Antidotes
digitalis antitoxin
V03AB24
Forms & Strengths
- Digoxin Immune Fab (ovine): 38 mg per vial
Adult Dosing
- Acute toxicity (known ingested dose): Number of vials = [Ingested dose (mg) x 0.8] / 0.6
- Acute toxicity (steady-state serum concentration known): Number of vials = [Serum concentration (ng/mL) x weight (kg)] / 100
- Chronic toxicity (unknown dose/concentration): Empiric dose of 3 to 6 vials (adults)
Pediatric Dosing
- Acute toxicity (known ingested dose): Number of vials = [Ingested dose (mg) x 0.8] / 0.6
- Acute toxicity (steady-state serum concentration known): Number of vials = [Serum concentration (ng/mL) x weight (kg)] / 100
- Chronic toxicity (unknown dose/concentration): Empiric dose of 1 to 2 vials (infants and children)
Indications
- Life-threatening digitalis intoxication (digoxin, digitoxin)
- Severe digitalis toxicity causing potentially lethal ventricular arrhythmias
- Progressive bradyarrhythmias unresponsive to atropine
- Severe hyperkalemia (serum potassium > 5.5 mEq/L) in the setting of acute digitalis toxicity
Mechanism of Action
- Fab fragments of ovine (sheep) polyclonal antibodies bind specifically to molecules of digoxin and digitoxin
- Inactivates the digitalis compound by forming an antigen-antibody complex
- Lowers free drug concentration in the serum, shifting equilibrium to draw tissue-bound digitalis into the extracellular space for renal elimination
Contraindications
- Known hypersensitivity to ovine (sheep) protein or Fab fragments
- Non-life-threatening digitalis toxicity where standard supportive care is sufficient
Adverse Reactions
- Worsening of low cardiac output or congestive heart failure due to withdrawal of digitalis effect
- Rapid ventricular response in patients with atrial fibrillation due to withdrawal of digitalis effect
- Hypokalemia as potassium shifts intracellularly
- Allergic reactions including anaphylaxis, urticaria, and rash
Drug Interactions
- Digitalis glycosides: pharmacological antagonism (primary intended effect)
- Other inotropic or antiarrhythmic agents: may have additive effects on cardiac conduction and contractility
Curated Content: Needs Vetting Before Put to Clinical Use