Binds excess digoxin or digitoxin molecules circulating in the blood
- Fab fragment-digoxin complex excreted by kidney - Net shifts the equilibrium away from binding of digoxin to receptors

Reversal of MoP receptor effects such as sedation, hypotension, respiratory depression, and the dysphoric effects of partial agonists
Will precipitate acute withdrawal symptoms in opiate addicts

- CVS: > 0.3 mg/kg → ↑MAP
- RESP: nil
- CNS: Drowsiness at high dose, Decreased pain tolerance
- OTHER: Sphincter of oddi spasm

-

91% absorption but Oral BA 2% due to extensive first-pass metabolism

-

46%

0.3 L/kg [DigiFab]
0.4 L/kg [Digibind]

2 L/kg
Highly lipid soluble

Nil

Liver
via glucuronidation to naloxone-3-glucouronide

Urine

25 ml/min/kg

Unbound: 11 hrs
Bound: 15-20 hrs

0.5-1.5 hrs

Anaphylaxis – rare
Digoxin Withdrawal: AF, heart failure, hypokalemia

Rapid onset of withdrawal symptoms in opioid drug addiction
At High Doses:
- Hypertension
- Tachycardia
- Arrhythmias

Monoclonal antibody (mAB) FAB (Fragment antigen-binding) fragment from sheep immunized with digoxin derivative

substituted oxymorphone derivative.
pKa = 8.0

Antidote

Antidote

- For treatment of acute and chronic digoxin overdose
- Treatment of toxicities of other cardiac glycosides: oleander, bufotoxin (cane toad), Chinese medicines

- the reversal of respiratory depression due to opioids
- the diagnosis of suspected opioid overdose and has been used in the
treatment of.
- clonidine overdose

Level 3

Level 3

Binds Digoxin Molecules

competitive antagonist at mu-, delta-,
kappa-, and sigma-opioid receptors

Onset: 0-60min
Peak: 30-360min

Onset: 1-3 mins
Peak effect: 15 mins
Duration: 30 mins
> Less than the effect site time of most opioids → requirement for repeat dosing or infusion.

powder
contains 38-40mg of digoxin-specific Fab fragments (which binds approx. 0.5mg Digoxin)
reconstitute with sterile water

clear solution for injection containing 0.02/0.4 mg/ml of naloxone hydrochloride

IV

Empiric: 10vials of Fab fragments

Known dose, no level:
Total body load = Dose (in mg) x 0.8 (BA of digoxin)
Number of vials = TBL x 2

Known concentration:
No of vials = [(serum digoxin concentration in ng/mL) x (patient's weight in kg)]/ 100

IV/IM

- Reversal of post-operative respiratory depression and coma: 20-40mcg IV PRN
- For opioid overdose reversal 0.4-2 mg IM/IV → Via infusion a 5mcg/kg/hr
- Reversal of S/Es of opioids: 1-4 mcg/kg
- Increased cardiac contractility in septic shock at doses 1mg/kg IV

effective in alleviating the pruritus, nausea,
and respiratory depression associated with the epidural or spinal administration of opioids.