Digoxin Immune Fab
(Ovine)
Digoxin Immune Fab (Digibind)
Ovine (Digibind)
Digoxin Immune Fab
(dih- JOX-in)
Pregnancy Category: C Digibind (Rx)

Classification: Digoxin antidote

Action/Kinetics: Digoxin immune Fab are antibodies that bind to digoxin. In cases of digoxin toxicity, the antibodies bind to digoxin and the complex is excreted through the kidneys. As serum levels of digoxin decrease, digoxin bound to tissue is released into the serum to maintain equilibrium and this is then bound and excreted. The net result is a decrease in both tissue and serum digoxin. Onset: Less than 1 min. Improvement in signs of toxicity occurs within 30 min. t 1/2: 15-20 hr (after IV administration). Each vial contains 38 mg of pure digoxin immune Fab, which will bind approximately 0.5 mg digoxin or digitoxin.

Uses: Life-threatening digoxin or digitoxin toxicity or overdosage. Symptoms of toxicity include severe sinus bradycardia, second- or third-degree heart block which does not respond to atropine, ventricular tachycardia, ventricular fibrillation.
NOTE: Cardiac arrest can be expected if a healthy adult ingests more than 10 mg digoxin or a healthy child ingests more than 4 mg. Also, steady-state serum concentrations of digoxin greater than 10 ng/mL or potassium concentrations greater than 5 mEq/L as a result of digoxin therapy require use of digoxin immune Fab.

Special Concerns: Use with caution during lactation. Use in infants only if benefits outweigh risks. Clients sensitive to products of sheep origin may also be sensitive to digoxin immune Fab. Skin testing may be appropriate for high-risk clients.

Side Effects: CV: Worsening of CHF or low CO, atrial fibrillation (all due to withdrawal of the effects of digoxin). Other: Hypokalemia. Rarely, hypersensitivity reactions occur, including fever and anaphylaxis.

How Supplied: Injection: 10 mg/mL

Dosage
?IV
Dosage depends on the serum digoxin concentration. A large dose has a faster onset but there is an increased risk of allergic or febrile reactions. The package insert should be carefully consulted. Adults, usual: Six vials (228 mg) is usuallly enough to reverse most cases of toxicity. Children, less than 20 kg: A single vial (38 mg) should be sufficient.