Digoxin Chronic Poisoning

Chronic digoxin poisoning is an under diagnosed condition that carries significant morbidity and mortality. Digoxin has a narrow therapeutic index and intoxication commonly develops in elderly patients with multiple co-morbidities. Use of digoxin immune Fab reduces mortality and may reduce hospital length of stay and cost of care

References

• Abad-Santos F, Carca AJ, Ibanez C et al. Digoxin level and clinical manifestations as determinants in the diagnosis of digoxin toxicity. Therapeutic Drug Monitoring 2000; 22(2):163-168.
• Antman EM, Wenger TL, Butler VP et al.  Treatment of 150 cases of life-threatening digitalis intoxication with digoxin-specific Fab antibody fragments: final report of a multicenter study.  Circulation 1990; 81(6):1744-1752.
• DiDomenico RJ, Walton SM, Sanoski CA et al. Analysis of the use of digoxin immune fab for the treatment of non-life-threatening digoxin toxicity. Journal of Cardiovascular Pharmacology and Therapeutics 2000; 5(2):77-85.
• Lapostelle F, Borron SW, Verdier C et al.  Digoxin-specifc Fab fragments in single first-line therapy in digitalis poisoning.  Critical Care Medicine 2008; 36:3014-3018.
• Marik PE, Fromm L. A case series of hospitalised patients with elevated digoxin levels. American Journal of Medicine 1998; 105(2):110-115.