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Second-line treatment for serious toxicity

Authoring team

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

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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