Key points

  • It is recommended to contact your poison centre in digoxin or cardiac glycosides poisonings potentially requiring digoxin-specific antibodies.
  • Hyperkalemia can be caused by acute digitalis intoxication, but it can also be present in chronic toxicity due to the deterioration of renal function. In either case, calcium is not recommended.
  • Most standard immunoassays for digoxin will measure both antibody-bound digoxin (inactivated) and free digoxin (active) therefore serum digoxin levels drawn during or after antidote administration are often "falsely" very elevated and uninterpretable. Note: many American-based references use ng/ml instead of nmol/L (1 ng/ml = 1.281 nmol/L).
  • On average, onset of action occurs within 20 min and reaches its maximum effect in 4 hours.
  • The rate of antidote administration (direct IV or slow IV infusion over 30 min.) is determined by the urgency of the situation (imminent cardiac arrest or not).

Last updated : 2023-02-01