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Digoxin use has declined since the 1990s but toxicity remains an issue, with over 139 patients admitted to Australian hospitals with cardiac glycoside toxicity in 2011–12. Manifestations of toxicity include gastrointestinal symptoms, lethargy, confusion and cardiac dysrhythmias.

The use of digoxin‐specific antibody fragments is indicated for the treatment of life‐threatening digoxin toxicity. The guidelines for the indication of digoxin‐specific antibody fragments vary, and include life‐threatening arrhythmia, cardiac arrest, hyperkalaemia above 5.0 mmol/L, along with moderate to severe gastrointestinal symptoms and serum digoxin concentration greater than 12 μg/L. The variations in guidelines are based on cost–benefit analysis, with each digoxin‐specific antibody fragments ampoule costing $1000 and each patient may require multiple ampoules. Digoxin‐specific antibody fragments are also associated with adverse effects, including electrolyte disturbances and, rarely, decompensated heart failure and atrial fibrillation with rapid ventricular response.

This MJA Medical Education shares more.

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Authors: Noor Lammoza, Maria Hormiz, Cherie Chiang, Chris Stead, Mustafa Ayhan and Samuel C Hume

Article Type: Medical Education