Digitek

[digoxin]

Overdosage & Contraindications
CONTRAINDICATIONS

Digitalis glycosides are contraindicated in patients with ventricular fibrillation or in patients with a known hyper-sensitivity to digoxin. A hypersensitivity reaction to other digitalis preparations usually constitutes a contraindication to digoxin.

OVERDOSAGE

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Treatment of Adverse Reactions Produced by Overdosage

Digoxin should be temporarily discontinued until the adverse reaction resolves. Every effort should also be made to correct factors that may con-tribute to the adverse reaction (such as electrolyte disturbances or concurrent medications). Once the adverse reaction has resolved, therapy with digoxin may be reinstituted, following a careful reassess-ment of dose.

Withdrawal of digoxin may be all that is required to treat the adverse reaction. However, when the primary manifestation of digoxin overdosage is a cardiac arrhythmia, additional therapy may be needed. If the rhythm disturbance is a symptomatic bradyarrhythmia or heart block, consideration should be given to the reversal of toxicity with DIGIBIND ® [Digoxin Immune Fab (Ovine)] (see below), the use of atropine, or the insertion of a temporary cardiac pacemaker.

However, asymptomatic bradycardia or heart block related to digoxin may require only temporary withdrawal of the drug and cardiac monitor-ing of the patient. If the rhythm disturbance is a ventricular arrhythmia, considera-tion should be given to the correction of electrolyte disorders, partic-ularly if hypokalemia (see below) or hypomagnesemia is present. DIGIBIND ® [Digoxin Immune Fab (Ovine)] is a specific antidote for digoxin and may be used to reverse potentially life-threatening ven-tricular arrhythmias due to digoxin overdosage.

Administration of Potassium

Every effort should be made to main-tain the serum potassium concentration between 4 and 5.5 mmol/ L. Potassium is usually administered orally, but when correction of the arrhythmia is urgent and the serum potassium concentration is low, potassium may be administered cautiously by the intravenous route. The electrocardiogram should be monitored for any evidence of potassium toxicity (e. g., peaking of T waves) and to observe the effect on the arrhythmia.

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