Digoxin 中毒時，維持呼吸功能、循環和生命徵象穩定為治療目標，給予digoxinspecific antibody fragments (digoxin-Fab) 應為輔助治療，digoxin-Fab 仿單建議劑量較大，藥品高成本因而出現成本效益 (cost–benefit) 議題。根據digoxin 藥動特性及澳洲毒理學監測計畫 (the Australian TOxicology Monitoring project , ATOM) 試驗，不論慢、急性中毒，先給1–2 瓶 (40–80 mg) digoxin-Fab，再依臨床反應（心電圖、血液動力學、血鉀⋯⋯等），必要時重覆投予。經digoxin-Fab 治療，監測全血digoxin 濃度 (total serum digoxin concentration) 同時也能檢測到FAB-digoxin complex，造成血清digoxin 濃度假性升高。因此使用digoxin-Fab 治療後應監測游離digoxin 濃度，或是待數天後監測全血digoxin 濃度避免干擾影響評估。

 

The goal of treatment for digoxin overdose is to maintain the stability of respiratory function, circulation, and vital signs. Digoxin-Fab is considered an adjunct therapy; however, the suggested dose of digoxin-Fab on the package insert is high, leading to concerns regarding cost-effectiveness. Based on the pharmacokinetics of digoxin and the Australian Toxicology Monitoring project (ATOM) study, regardless of chronic or acute toxicity, an initial administration of 1 to 2 bottles (40–80mg) of digoxin-Fab is recommended, followed by close monitoring of the clinical response, with the option to repeat the same dose as needed. Following the administration of digoxin-Fab, if the total serum digoxin concentration is monitored, it will detect the presence of the FAB-digoxin complex, resulting in a false increase in the serum digoxin concentration. Therefore, it is advisable to monitor the concentration of free digoxin after the administration of digoxin-Fab, or alternatively, monitor the concentration of total digoxin after several days to avoid interference and ensure accurate assessment.

 

 

Submitted for publication: 2022.8.4; Accepted for publication: 2023.5.27