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Dosing regimen for digoxin-specific antibody (Fab) fragments in patients with digoxin toxicity

Michael Levine, MD
Ayrn O'Connor, MD
Section Editors
Stephen J Traub, MD
Michele M Burns, MD, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Digoxin-specific antibody (Fab) fragments are the definitive treatment for patients with severe digitalis poisoning.

Prior to the advent of digoxin-specific antibodies, treatment for cardiac glycoside toxicity was largely supportive [1]. In 1976, antibody fragments were first used successfully to treat patients [2]. These antibodies are highly effective, safe, and widely used in clinical practice [3].

The dosing of digoxin-specific antibody (Fab) fragments based upon different clinical scenarios is discussed here. The indications for treatment with Fab fragments, the diagnosis and general management of digitalis poisoning, and the clinical use of digitalis are all reviewed separately. (See "Digitalis (cardiac glycoside) poisoning", section on 'Antidotal therapy with antibody (Fab) fragments' and "Use of digoxin in heart failure due to systolic dysfunction" and "Control of ventricular rate in atrial fibrillation: Pharmacologic therapy", section on 'Digoxin' and "Treatment with digoxin: Initial dosing, monitoring, and dose modification".)


Digoxin-specific antibody (Fab) fragments are purified preparations consisting of the Fab portion of IgG antidigoxin antibodies derived from immunized sheep. These fragments bind free digoxin, thereby forming digoxin-immune fragment complexes. As the level of free digoxin in plasma falls, the resulting concentration gradient facilitates dissociation of digoxin from the sodium-potassium ATPase.

Digoxin-immune fragment complexes are renally excreted. Because the size of the digoxin-immune complex molecule is large, hemodialysis is not an effective means of removal.


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Literature review current through: Sep 2016. | This topic last updated: Nov 4, 2015.
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