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The Dosing Regimen for Digoxin-Specific Antibody Fragments in Patients With Digoxin Toxicity

Published on Nov 01, 2022 and last reviewed on Jan 24, 2023   -  4 min read


Digoxin-specific antibody fragments are used for the treatment of Digoxin toxicity. Read below to know more.


Digoxin toxicity will cause adverse health effects. It may occur due to accidental ingestion or consumption of large doses of Digoxin for therapeutic purposes. Digoxin toxicity mainly results in cardiac complications. Acute toxicity will cause nausea, discomfort, irritability, and vomiting. Digoxin-specific antibody fragments (Digoxin immune fab) are used as antidotes to reduce Digoxin toxicity and adverse effects. They are administered based on the levels of Digoxin present in the body.

What Is Digoxin Toxicity?

Digoxin is a drug used to treat various cardiovascular diseases. Its toxicity can occur due to accidental ingestion of a large amount of Digoxin or chronic use of Digoxin for therapeutic purposes in large amounts. Some people may develop low tolerance to Digoxin due to underlying medical conditions and develops toxicity. Diuretic drugs (for removing excess fluid from the body) are usually given to patients with heart diseases. These drugs remove excess fluids present in the body and cause low levels of potassium in the body (hypokalemia). Low potassium levels in the body increase the risk of Digoxin toxicity. Magnesium levels can also increase the toxicity of Digoxin in our bodies. Low magnesium levels are associated with patients consuming Digoxin for heart diseases. Certain drugs like Verapamil, Amiodarone, Quinidine, and Flecainide interact with Digoxin and cause toxicity.

What Are the Signs of Digoxin Toxicity?

Cardiac toxicity is the most important effect of Digoxin overdose. Acute toxicity will cause symptoms like vomiting, vertigo, and nausea. Chronic toxicity results in nonspecific symptoms. Common signs and symptoms associated with Digoxin toxicity are the following:

What Are the Treatment Options for Digoxin Toxicity?

Emergency medical care must be given to patients with Digoxin toxicity. Symptoms associated with acute Digoxin toxicity, like vomiting, breathlessness, diarrhea, and irregular heart rate, must be managed immediately. Drugs like Phenytoin, magnesium, and Lidocaine can be used for toxicity management. Phenytoin and Lidocaine will help to reduce ventricular automaticity induced by Digoxin. Ventricular arrhythmia induced by Digoxin toxicity can be suppressed using magnesium. The most effective and important treatment option available for Digoxin toxicity is a Digoxin-specific antibody (Digoxin immune fab). They are highly effective in reducing life-threatening complications associated with Digoxin toxicity.

What Are the Indications for the Use of Digoxin-Specific Antibody Fragments?

  • Acute ingestion of more than 10 milligrams of Digoxin in healthy adults.

  • Acute ingestion of more than four milligrams of Digoxin in children.

  • A serum Digoxin concentration of more than ten nanograms per milliliter.

  • Severe gastrointestinal problems.

  • Potassium concentration of more than five millimoles per liter (hyperkalemia).

  • Symptoms of organ dysfunction.

What Is the Dosing Regimen for Digoxin-Specific Antibody Fragments?

Digoxin-specific antibody fragments (Digoxin immune fab) are used as antidotes to treat the symptoms of acute Digoxin ingestion and toxicity due to chronic therapy. They are antibodies obtained from anti-Digoxin antibodies cultured in sheep. The dose of Digoxin-specific antibody fragments is determined based on the amount of Digoxin to be neutralized.

  • Dose for Acute Ingestion of Digoxin - 760 milligrams or 20 vials of Digoxin-specific antibody (Digoxin immune fab) is given to treat life-threatening Digoxin toxicity in children and adults. During administration in children, volume overload is monitored thoroughly. Large doses of Digoxin-specific antibodies have a fast onset of action but may cause febrile reactions. Ten vials of Digoxin-specific antibody fragments will be administered initially, and after watching the body response, the next ten vials will be given if needed.

  • Dose for Chronic Toxicity of Digoxin - Six vials or 228 milligrams for chronic toxicity are adequate to reduce toxicity and symptoms. Small doses of one vial are usually sufficient in small children and infants.

How Is Digoxin-Specific Antibody Dosage Calculated?

The amount of Digoxin-specific antibody (Digoxin fab) administered is calculated based on two different methods. The first one is based on the Digoxin levels ingested, and the other one is based on the weight of the person and serum Digoxin concentration.

  • Acute Toxicity With Unknown Levels - One vial of Digoxin-specific antibody (Digoxin immune fab) contains 38 milligrams of Digoxin-specific Fab fragments that will bind to 0.5 milligrams of Digoxin. Thus we can calculate the total number of vials required for the patient by dividing the total Digoxin body load in milligrams by 0.5 milligrams per vial. In acute toxicity, the total body load of Digoxin in milligrams will be approximately equal to the amount of Digoxin tablets ingested in milligrams. It is calculated by multiplying the Digoxin dose ingested by 0.8, which is the bioavailability of Digoxin.

  • Known Digoxin Concentration - When the Digoxin concentration is known, Digoxin-specific antibody concentration is calculated by using the product of drug concentration and weight in kilograms divided by 100.

  • Ingested Amount and Serum Digoxin Level Unknown - In this situation, ten vials of Digoxin-specific antibody fragments (Digoxin immune fab) are given to the patient, and a clinical response is observed. Further doses are added to the patient depending on the clinical condition. Five vials are given initially for small children with less than 20 kilograms of weight.

What Are the Side Effects of Using Digoxin-Specific Antibodies?

The use of Digoxin-specific antibodies may cause side effects in some people. Proper allergic history must be taken before administration.

Side effects include the following:

  • Itching.

  • Cough.

  • Skin redness.

  • Short of breath.

  • Swelling of tongue, face, and lips.

  • Wheezing.

  • Increased urination.

  • Muscle weakness.

  • Increased thirst.

  • Irregular heartbeats.

  • Headache.

  • Joint pain.


Digoxin-specific antibody fragments (Digoxin immune fab) are the widely accepted treatment option for Digoxin toxicity. It is relatively safe for the majority of patients. Digoxin-specific antibody fragments will help to save patients from a life-threatening arrhythmia caused by Digoxin toxicity. The dose of Digoxin-specific antibody fragments administered to each patient is calculated based on the Digoxin level ingested, the weight of the patient, and serum Digoxin levels.

Frequently Asked Questions


What Is the Treatment for Digoxin Toxicity?

Digoxin toxicity can develop from accidentally ingesting a significant dose of Digoxin or chronically using Digoxin excessively for therapeutic purposes. Digoxin poisoning requires immediate medical attention. Toxicology management involves using medications such as Phenytoin, magnesium, and Lidocaine. A Digoxin-specific antibody (Digoxin immune fab) is the most successful and significant therapy for Digoxin poisoning.


What Is the Antidote for Digoxin Toxicity?

Digoxin-specific antibody antigen-binding fragments (Digoxin immune fab) are an efficient antidote for life-threatening Digoxin toxicity. Digibind binds to Digoxin molecules, lowering free Digoxin. This medicine is an antidote to Digoxin. It will be given to patients suffering from life-threatening Digoxin toxicity, including ventricular arrhythmias.


What Is the Recommended Dosage of Digoxin?

Digoxin is used to treat atrial fibrillation, heart failure, and heart rhythm disorders. Digoxin should be taken exactly as suggested by the doctor. Read all instructions or medication guidelines and follow the directions in the prescription before taking Digoxin. The recommended adult dosage of Digoxin for treating congestive heart failure is given below.
- Tablets - 500 to 750 mcg.
- Capsules - 400 to 600 mcg.
- Injection - 400 to 600 mcg. 


Why Is Magnesium Administered for Digoxin Toxicity?

Digoxin-induced cardiac arrhythmias may be treated with intravenous magnesium. Magnesium effectively treats acute Digoxin-induced rhythm abnormalities and restores the transmembrane potassium gradient. In addition, magnesium sulfate has antidysrhythmic effects that help in digoxin toxicity therapy.


What Are the Indications for the Use of Digoxin Immune Fab?

Following are the indications for using Digoxin-specific antibody fragments (Digoxin immune fab). 
- Acute Digoxin consumption of more than 10 mg in a healthy person.
- Severe gastric symptoms and organ dysfunction after Digoxin toxicity.
- Acute Digoxin consumption of more than four milligrams in children.
- More than ten nanograms of Digoxin per milliliter in the serum.


What Are the Symptoms of Digoxin Toxicity?

The most significant side effect of Digoxin overdose is cardiac toxicity. Symptoms of acute poisoning include nausea, vertigo, and vomiting. Chronic poisoning causes symptoms that are not specific. Confusion, irregular pulse, loss of appetite, heart block, overall sweating, decreased urine output, and blurred vision are other symptoms associated with Digoxin toxicity.


What Are the Uses of Digoxin?

Digoxin is usually used in combination with other drugs to treat heart failure. It is used to treat the following conditions: 
- Mild to moderate heart failure in adult patients. 
- To stimulate myocardial contraction in children with heart failure.
- To keep the ventricular rate under control in adult patients with persistent atrial fibrillation.


What Is a Digoxin-specific Antibody?

Digoxin immune fab, also known as a digoxin-specific antibody, is an antidote for digoxin overdose. It is generated from the immunoglobulin fragments from lambs that have already been inoculated with a digoxin derivative. Acute and chronic digoxin poisoning can be managed using digoxin-specific antibody fragments (Digoxin-fab), and it is recognized as a safe and reliable therapy.

Article Resources

Last reviewed at:
24 Jan 2023  -  4 min read




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