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Digoxin Immune Fab Dosage

Applies to the following strength(s): 38 mg ; 40 mg

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Digitalis Glycoside Toxicity

Unknown amount of ingestion: 800 mg IV infusion if acute ingestion, 240 mg IV infusion if chronic ingestion.

Dosing for Ingestion of a Single Large Dose:
Dose (in # of vials) = (Total digitalis body load in mg) / (0.5 mg of digitalis bound per vial).
Total digitalis body load in mg = (number of tablets/capsules ingested) x (mg strength of the tablet/capsule) x (bioavailability of tablet/capsule). Digoxin tablets and elixir are 80% bioavailable, digoxin capsules and injection are 100% bioavailable.

Dosing based on Serum Level:
Digoxin: Dose (in # of vials) = (Serum digoxin level in ng/mL) x (weight in kg) / (100).
Digitoxin: Dose (in # of vials) = (Serum digitoxin level in ng/mL) x (weight in kg) / (1000).

Digoxin immune Fab should be administered intravenously once over at least 30 minutes or, in the case of imminent cardiac arrest, as a bolus injection.

The above dosing scenarios are based on the following: each vial contains 40 mg of immune Fab; each vial will bind approximately 0.5 mg of cardiac glycoside.

Usual Pediatric Dose for Digitalis Glycoside Toxicity

Dosing for Ingestion of a Single Large Dose:
Dose (in # of vials) = (Total digitalis body load in mg) / (0.5 mg of digitalis bound per vial).
Total digitalis body load in mg = (number of tablets/capsules ingested) x (mg strength of the tablet/capsule) x (bioavailability of tablet/capsule). Digoxin tablets and elixir are 80% bioavailable, digoxin capsules and injection are 100% bioavailable.

Children less than or equal to 20 kg: Dilution of reconstituted vial to 1 mg/mL may be desirable for doses of 3 mg or less.
Dose ( in # of mg) = Dose (in # vials) x 38 mg/vial.
Dose (in # of vials) = (Serum digoxin level in ng/mL) x (weight in kg) / (100).

Digoxin immune Fab should be administered intravenously once over at least 30 minutes or, in the case of imminent cardiac arrest, as a bolus injection. The vial may be reconstituted and administered undiluted using a tuberculin syringe in infants and small children requiring small doses.

The above dosing scenarios are based on the following: each vial contains 40 mg of immune Fab; each vial will bind approximately 0.5 mg of cardiac glycoside.

Renal Dose Adjustments

No adjustments recommended. However, since digoxin immune Fab is eliminated primarily by the kidneys, patients with moderate to severe renal dysfunction should remain under close clinical and cardiac monitoring for a prolonged period to ensure against the possibility of recrudescent digitalis toxicity.

Liver Dose Adjustments

Data not available

Dose Adjustments

Dosage based on body load of digoxin (using either an approximation of amount ingested or a serum digoxin concentration). In general, larger doses are often necessary and have a faster onset of action, but also increase the risk of a febrile or hypersensitivity reaction.

Precautions

Close monitoring of temperature, blood pressure, ECG, and serum potassium is recommended. Hypokalemia may develop rapidly.

Dialysis

Digoxin immune Fab is not cleared by hemodialysis.

Other Comments

Standard therapy includes withdrawal of digoxin and correction of electrolyte disturbances, hypoxia, and acid-base disorders. If heart failure develops during withdrawal from digoxin toxicity, alternative inotropic support and/or other measures (such as diuretics/vasodilators) may be necessary.

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