digoxin immune Fab (Digibind)
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Introduction
Tradename: Digibind.
Indications
- adjunctive therapy for life-threatening or potentially life-threatening digoxin or digitoxin toxicity
- oleander toxicity
Dosage
- Digoxin toxicity 2-20 vials IV over 15-30 minutes
- 40 mg of Digibind binds approximately 0.6 mg of glycoside
Injection: 38-40 mg/vial.
TBL: total body load of digoxin in mg
C: measured serum concentration in ng/mL
TBL = C x 5.6 x body weight (kg)/1000
Digibind dose (mg) = TBL x 76
Digibind dose (vials) = C (ng/mL) x weight (kg)/100
Pharmacokinetics
- peak concentrations occur at the completion of infusion
- free (unbound) glycoside concentrations decline within 15-30 minutes
- measure serum concentrations of digoxin may increase 10-20 fold, but don't correlated with free dixogin
- eliminated in the urine
- elimination 1/2life is 12-20 hours
elimination via kidney
1/2life = 12-20 hours
Adverse effects
Drug interactions
- digoxin: do not attempt to redigitalize for 2-3 days, or for 5-7 days if evidence of renal insufficiency
Mechanism of action
- high-affinity, specific antigen-binding fragments bind free (unbound) digoxin or digitoxin
- blocks & reverses inhibition of Na+/K+ ATPase
More general terms
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Department of Veterans Affairs, VA National Formulary