DigiFab (Digibind) Dosing for Digoxin Poisoning
Doses DigiFab in patients with confirmed digoxin poisoning or overdose.
This dosing tool is intended to assist with calculation, not to provide comprehensive or definitive drug information. Always double-check dosing of any drug and consult a pharmacist when necessary.
Therapeutic range for serum digoxin level is 0.8–2.0 ng/mL (1.0–2.6 nmol/L). If acute poisoning and serum digoxin confirmed >10 ng/mL, give empiric dose (10-20 vials). See Evidence for details.
Additional considerations for treatment of digoxin toxicity include:
- Atropine 0.5 mg IV for acute toxicity if bradydysrhythmias or high degree AV block.
- Cautious correction of electrolyte abnormalities, specifically hypokalemia and hypomagnesemia (may result in dysrhythmias at lower serum digoxin levels).
Advice
Frequent premature ventricular complexes (PVCs) may be closely followed by ventricular dysrhythmias.
Critical Actions
- Potassium abnormalities, specifically hypokalemia, may worsen digoxin toxicity, even at therapeutic digoxin levels.
- If mild hyperkalemia, correction is not advised, as treatment with DigiFab will decrease potassium concentrations.
- Treatment to lower serum potassium concentrations should be performed prior to DigiFab administration only if (1) hyperkalemia is believed to be worsening AV nodal block and bradycardia AND (2) DigiFab is not immediately available.
- If hypokalemia, cautious correction is advised prior to the administration of DigiFab.
- If worsening toxicity/dysrhythmia or if toxicity does not improve with correction of hypokalemia, DigiFab should be immediately administered.
- Though debated, calcium salts should not be administered to patients with hyperkalemia secondary to digoxin toxicity.
- Transcutaneous and especially transvenous pacing should be avoided in patients with digoxin toxicity due to risk for precipitating dysrhythmias.