![]() Oral solution: 3.0 to 4.5 mcg/kg once a day.The most common adverse reactions (>7%) related to DIGIFab administration are worsening congestive heart failure (13%), hypokalemia (13%) and worsening atrial fibrillation (7%).Total loading dose: Administer one-half the total loading dose initially (all formulations), then give one-fourth the total loading dose every 6 to 8 hours for two doses (IV and tablets), or give additional fractions every 4 to 8 hours (oral solution). The total serum digoxin concentration may rise precipitously following administration of DIGIFab, but this will be almost entirely bound to the Fab fragment and not able to react with receptors in the body. If possible, obtain serum digoxin samples before DIGIFab administration to establish the level of serum digoxin at the time of diagnosis. This may take several days or a week or more in patients with markedly impaired renal function. Thus, standard serum digoxin concentration measurements may be clinically misleading until the Fab fragments are eliminated from the body. Laboratory TestsĭIGIFab may interfere with digitalis immunoassay measurements. Monitoring of free (unbound) digoxin concentrations after the administration may be appropriate. Monitor patients with severe renal failure who receive DIGIFab for a prolonged period for possible recurrence of toxicity. The elimination half-life of DIGIFab in renal failure has not been clearly defined. Patients with known allergies to sheep protein or those who have previously received intact ovine antibodies or Fab are particularly at risk for an anaphylactic reaction.ĭo not administer DIGIFab to patients with a known history of hypersensitivity to papaya or papain unless the benefits outweigh the risks and appropriate management for anaphylactic reactions is readily available. Carefully monitor patients for signs and symptoms of an acute allergic reaction and if one occurs, stop the infusion and treat immediately with appropriate emergency medical care. Hypersensitivity ReactionsĪnaphylaxis and hypersensitivity reactions are possible. Postpone re-digitalization, if possible, until the Fab fragments have been eliminated this may require several days or a week or longer in patients with impaired renal function. Monitor frequently and provide additional inotropic support if needed. Patients with poor cardiac function may deteriorate secondary to the withdrawal of the inotropic action of digoxin by DIGIFab. Rapid drop in serum potassium concentration may occur after treatment. Consider toxic effects of other drugs or poisons in cases where signs and symptoms of digitalis toxicity are not relieved by administration of DIGIFab. Suicidal ingestion may result from more than one drug. IMPORTANT SAFETY INFORMATION Warnings and Precautions General ![]() Manifestations of life-threatening toxicity of digoxin overdose such as severe ventricular arrhythmias, progressive bradycardia, and second or third degree heart block not responsive to atropine, serum potassium levels exceeding 5.5 mEq/L in adults or 6 mEq/L in children with rapidly progressive signs and symptoms of digoxin toxicity.Chronic ingestions causing steady-state serum digoxin concentrations >6 ng/mL in adults or 4 ng/mL in children.Known suicidal or accidental consumption of fatal doses of digoxin: 10 mg or more of digoxin in healthy adults, or 4 mg (or more than 0.1 mg/kg) in healthy children, or ingestion of an amount that can cause steady state serum concentrations of ≥10 ng/mL.DIGIFab is indicated for the treatment of patients with life-threatening or potentially life-threatening digoxin toxicity or overdose, including: ![]()
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