Digoxin antidote (Fab fragments)
Digoxin-specific antibody fragments
Brand names: DigiFab
Adult dose
Dose: Calculate from ingested dose or steady-state level (typically 5–20 vials IV); empiric 10–20 vials in cardiac arrest
Route: IV
Frequency: Single course; repeat per response
Clinical pearls
- TOXBASE / NPIS: indicated for severe digoxin toxicity — life-threatening arrhythmia, K+ >5.5, large overdose, haemodynamic instability
- BSH / Resus Council UK adjunct in digoxin-related cardiac arrest
- Free digoxin level falls rapidly after Fab; clinical response is the key endpoint
Contraindications
- Sheep / ovine product hypersensitivity
- Hypersensitivity
Side effects
- Hypersensitivity / anaphylaxis
- Hypokalaemia (rapid intracellular shift)
- Worsening of underlying HF/AF
- Rebound digoxin toxicity (rare)
Interactions
- Renders subsequent digoxin levels (total) uninterpretable for several days
Monitoring
- ECG (continuous)
- Potassium
- Magnesium
- Renal function
- Conscious level
Reference: BNF; TOXBASE / NPIS; Resus Council UK; SmPC; https://bnf.nice.org.uk/drugs/digoxin-specific-antibody-fragments/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
Pathways
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
- Syncope Assessment · ESC 2018 Syncope Guidelines; NICE NG109
- Acute Chest Pain · NICE CG95; ESC 2023 ACS Guidelines