Treating digoxin toxicity: is less more?

3 out of 5 stars Digoxin-specific antibody fragments in the treatment of digoxin toxicity. Chan BSH, Buckley NA. Clin Toxicol 2014 Aug 4 [Epub ahead of print] Abstract This long detailed paper seems to be a manifesto masquerading as a review article. It is quite informative and well worth reading. But I’d keep in mind that the authors appear to have a (not so) hidden agenda: to decrease the dose of digoxin-specific antibody fragments administered in most cases of acute and chronic digoxin toxicity. The authors state their objective up front: To review the pharmacology, efficacy, effectiveness, indications, safety and dosage of digoxin-Fab. On the basis of the reviewed data. to propose a regimen of administering digoxin-fab to patients with digoxin poisoning based on pharmacokinetic principles. Although they identified 140 relevant citations, they are not clear on exactly how these were selected. (Their reference list contains only 69 papers.) They note that there have been no randomized clinical trials on digoxin toxicity. The authors say this about indications for using digoxin-specific antibody fragments: There is general agreement that digoxin-Fab is indicated in patients with life-threatening tachy-bradyarrhythmias, hyperkalaemia (> 6 mmol/L) or haemodynamic instability with concentrations (e.g. digoxin > 2 μg/L or > 2.6 nmol/L) that support digoxin may be a contributing cause. They point out that in acute toxicity, dose calculations based on serum digox...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical digibind digifab digoxin specific antibody fragments digoxin toxicity Source Type: news