second-line treatment for serious toxicity
Last reviewed 10/2022
Consult expert advice.
If first-line treatment for digoxin toxicity fails, the intervention of choice is Digoxin Specific Fab (DSFab) therapy:
- DSFab's are biologically active fragments of digoxin- neutralising antibodies
- patients respond within 30 min, with full effect seen in 3-4 hr
- the dose of DSFab is calculated by multiplying the amount of digoxin ingested by 60 e.g. 5 mg of digoxin is neutralised by 300 mg of DSFab
Other treatments:
- propranolol:
- 1-2 mg i.v. slowly to control ectopics and tacharrythmias
- atropine:
- 0.6 mg i.v. may control bradycardias
- temporary pacing if there is persistent heart block
- DC cardioversion:
- risks of inducing heart block or tachycardias
- indicated in cases of life-threatening arrythmia where DSFab is not considered appropriate
- cardioversion should begin with low energies e.g. 10 J