trademark for a preparation of digoxin immune Fab (ovine), an antidote for digoxin or digitoxin overdose.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

digoxin immune Fab

(di-jox-in im-myoon fab) ,


(trade name),


(trade name)


Therapeutic: antidotes
Pharmacologic: antibody fragments
Pregnancy Category: C


Serious life-threatening overdosage with digoxin.


An antibody produced in sheep that binds antigenically to unbound digoxin in serum.

Therapeutic effects

Binding and subsequent removal of digoxin, preventing toxic effects in overdose.


Absorption: Administered IV only, resulting in complete bioavailability.
Distribution: Widely distributed throughout extracellular space.
Metabolism and Excretion: Excreted by the kidneys as the bound complex (digoxin immune Fab plus digoxin).
Half-life: 14–20 hr.

Time/action profile (reversal of arrhythmias and hyperkalemia; reversal of inotropic effect may take several hr)

IV30 min (variable)unknown2–6 hr


Contraindicated in: No known contraindications.
Use Cautiously in: Known hypersensitivity to sheep proteins or products;Children, pregnancy, or lactation (safety not established).

Adverse Reactions/Side Effects


  • re-emergence of atrial fibrillation
  • re-emergence of HF

Fluid and Electrolyte

  • hypokalemia (life-threatening)


Drug-Drug interaction

Prevents therapeutic response to digoxin.


Digibind—38 mg of digoxin immune Fab will bind 0.5 mg of digoxin. Each vial contains 38 mg of digoxin immune Fab; DigiFab—40 mg of digoxin immune Fab will bind 0.5 mg of digoxin. Each vial contains 40 mg of digoxin immune Fab

Known Amount of Digoxin Ingested (Administered)

Intravenous (Adults and Children) For digitalis glycoside toxicity due to digoxin tablets, oral solution, or IM digoxin—dose of digoxin ingested (mg) × 0.8/1000 × 38. For digitalis glycoside toxicity due to digoxin capsules, IV digoxin—dose of digoxin ingested (mg)/0.5 × 38.

Known Serum Digoxin Concentrations (SDCs)

Intravenous (Adults and Children) Digibind—Dose (mg)=SDC (nanograms/mL) × body weight (kg)/100 × 38; DigiFab—SDC (nanograms/mL) × body weight (kg)/100 × 40.

Unknown Amount Ingested/SDCs Unavailable

Intravenous (Adults and Children) Digibind—760 mg (20 vials); DigiFab—800 mg (20 vials).

Toxicity during chronic digoxin therapy

Intravenous (Adults and Children) Digibind—228 mg (6 vials); DigiFab—240 mg (6 vials).


Powder for injection, lyophilized (Digibind): 38 mg/vial
Powder for injection, lyophilized (DigiFab): 40 mg/vial

Nursing implications

Nursing assessment

  • Monitor ECG, pulse, BP, and body temperature before and during treatment. Patients with atrial fibrillation may develop a rapid ventricular response as a result of decreased digoxin levels.
  • Assess patient for increase in signs of HF (peripheral edema, dyspnea, rales/crackles, weight gain).
  • Lab Test Considerations: Monitor serum digoxin levels before administration.
    • Monitor serum potassium levels frequently during treatment. Before treatment, hyperkalemia usually coexists with toxicity. Levels may decrease rapidly; hypokalemia should be treated promptly.
    • Free serum digoxin levels fall rapidly after administration. Total serum concentrations rise suddenly after administration but are bound to the Fab molecule and are inactive. Total serum concentrations will decrease to undetectable levels within several days. Serum digoxin levels are not valid for 5–7 days after administration.

Potential Nursing Diagnoses

Deficient knowledge, related to medication regimen (Patient/Family Teaching)


  • Cardiopulmonary resuscitation equipment and medications should be available during administration.
    • Delay redigitalization for several days until the elimination of digoxin immune Fab from the body is complete.
  • Intravenous Administration
  • pH: 6.0–8.0.
  • Intermittent Infusion: Diluent: Reconstitute each vial in 4 mL of sterile water for injection and mix gently. Solution will contain a concentration of 9.5 mg/mL (Digibind) or 10 mg/mL (DigiFab). May be further diluted with 0.9% NaCl to achieve the concentration below. Reconstituted solution should be used immediately but is stable for 4 hr if refrigerated. For small doses in infants and children, a reconstituted 38-mg vial can be diluted with 34 mL of 0.9% NaCl (Digibind) or 36 mL of 0.9% NaCl (DigiFab) for a concentration of 1 mg/mL. Concentration: 1 mg/mL.
  • Rate: Infuse over 30 min through a 0.22-micron membrane filter. If cardiac arrest is imminent, rapid direct IV injection may be used. Do not use rapid direct injection in other patients because of increased risk of adverse reactions. Small doses in infants and children may be administered with a tuberculin syringe.
  • Incompatibility: Information unavailable. Do not mix with other drugs or solutions.

Patient/Family Teaching

  • Explain the procedure and purpose of the treatment to the patient.
  • Instruct patient to notify health care provider immediately if signs of delayed allergic reaction (rash, pruritus, urticaria) occur after hospital discharge.

Evaluation/Desired Outcomes

  • Resolution of signs and symptoms of digoxin toxicity.
    • Decreased digoxin or level without major side effects.
Drug Guide, © 2015 Farlex and Partners
A therapeutic agent consisting of antigen binding fragments (Fab) derived from antidigoxin antibodies raised in sheep, which have a molecular weight of 46kD. It is used to manage digoxin overdose, and has been used successfully for digitoxin overdose
Adverse effects Rare, in patients with a history of allergy, especially to antibiotics; low cardiac output states and congestive heart failure may be exacerbated by withdrawal of the inotropic effects of digitalis. Hypokalemia may occur from re-activation of (sodium, potassium) ATPase
Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.
References in periodicals archive ?
Upon the attending physician's arrival to the PICU a nurse documented that he was notified of the digoxin administration error and asked if Digibind should be given.
Digibind, an antidote for digoxin toxicity was administered.
Digoxin toxicity can be rapidly and safely reversed by administration of anti-dioxin immune fragments (Fab) such as DIGIBIND [R], which has been available in the US since 1986.
Benjamin was transferred to the Birmingham hospital to receive the antidote Digibind. During the journey he was continually resuscitated.
The companies cite reports from the Food and Drug Administration that DigiFab and GlaxoSmithKline PLC's Digibind have been reduced to limited inventories.
Antibody-targeted imaging reagents Mouse 23 Rat 24 Antibody-targeted drugs Mouse 23 Rat 24 Anti-thymocyte globulin Horse 25 Rabbit 26 Anti-snake venom Horse 27 Calcitonin Salmon 28 Digibind (anti-digoxin Fab) Sheep 29 Factor VIII Pig 30 Insulin Pig 31 Vaccines Rabbit 32 Chicken 33 Patent medicines Rabbit 34 Table 2.
Nonetheless, one can agree that results from the Stratus II and AxSYM may be suitable for monitoring the course of Digibind treatment.
Green, entitled "Serum digoxin in the presence of Digibind: determination of digoxin by the Abbott AxSYM and Baxter Stratus II immunoassays by direct analysis without pretreatment of serum samples" (Clin Chem 1998;44:1947-50), the concentration of Digibind given in parentheses in the sentence at the bottom of the second column on page 1948 is incorrect.
Digibind [R] (Glaxo Wellcome) is the most common brand of anti-digoxin Fab fragments used in the United States and worldwide.
Digibind [R] (Digoxin Immune FAB) given to patients who are digitoxic can cause substantial interferences in tracking therapeutic concentrations of digoxin depending on the type of assay methodology used.
Specimens from patients treated with digoxin antidote (e.g., Digibind) give misleading values for digoxin concentrations by most immunoassays tested to date (101).
Also in this case, the intravenous administration of the Fab fragment of antidigoxin antibodies (Digibind) determined a significant reduction in her blood pressure.