digoxin immune fab digifab logo DIGIFab

DIGIFab Rapidly Resolved Potentially
Fatal Digoxin Toxicity

  • DIGIFab rapidly neutralized free digoxin to resolve the cardiotoxic effects and other clinical manifestations of potentially life-threatening digoxin toxicity.1,2

Proven Results in Clinical Trials1,2

DIGIFab rapidly neutralized digoxin to undetectable concentrations2,*

digoxin toxicity treatment digifab efficacy chart

In this comparative pharmacokinetics study, 16 healthy subjects were administered 1 mg intravenous digoxin followed 2 hours later by 30-minute infusion of an approximately equimolar neutralizing dose of DIGIFab (n=8) or Digibind (n=8). Free digoxin concentrations were analyzed at predetermined time intervals (0.5, 1, 2, 4, 6, 10, 22, and 46 hours after DIGIFab administration).
Figure adapted with permission from Wolters Kluwer Health, Inc.: Ward SB et al. Comparison of the pharmacokinetics and in vivo bioaffinity of DigiTAb versus Digibind. Ther Drug Monit. 2000;22(5):599-607. https://journals.lww.com/drug-monitoring/Abstract/2000/10000/Comparison_of_the_Pharmacokinetics_and_In_Vivo.16.aspx

DIGIFab Rapidly Resolved the Cardiotoxic Effects and Other Clinical Manifestations of Potentially Life-Threatening Digoxin Toxicity1,†

digoxin immune fab digifab neutralizes image

Serum free digoxin
 concentrations were undetectable
in all patients

digoxin toxicity early recognition image

ECG abnormalities
within 4 hours
in 67% of patients

digoxin immune fab digifab clinically proven image

Complete resolution of
was achieved within
4 hours in 47% of patients

  • Complete resolution of digoxin toxicity was achieved within 20 hours in 93% of patients.
  • The most common adverse reactions (>7%) related to DIGIFab administration are worsening congestive heart failure (13%), hypokalemia (13%), and worsening atrial fibrillation (7%).

Results from a prospective multicenter safety, efficacy, and pharmacokinetic study in patients presenting with life-threatening digoxin toxicity (N=15) conducted in the United States and Finland. Results were compared with historical data on Digibind. Patients received doses of DIGIFab based on its theoretical binding capacity for digoxin and based on the known amount of digoxin ingested or on blood concentrations of digoxin at the time of admission.1


  1. DIGIFab Digoxin Immune Fab (ovine) [package insert]. West Conshohocken, PA: BTG International Inc.; 2017.
  2. Ward SB, Sjostrom L, Ujhelyi MR. Comparison of the pharmacokinetics and in vivo bioaffinity of DigiTAb versus Digibind. Ther Drug Monit. 2000;22(5):599-607.


DIGIFab is indicated for the treatment of patients with life-threatening or potentially life-threatening digoxin toxicity or overdose, including:

  • Known suicidal or accidental consumption of fatal doses of digoxin: 10 mg or more of digoxin in healthy adults, or 4 mg (or more than 0.1 mg/kg) in healthy children, or ingestion of an amount that can cause steady state serum concentrations of ≥10 ng/mL;
  • Chronic ingestions causing steady-state serum digoxin concentrations >6 ng/mL in adults or 4 ng/mL in children;
  • Manifestations of life-threatening toxicity of digoxin overdose such as severe ventricular arrhythmias, progressive bradycardia, and second or third degree heart block not responsive to atropine, serum potassium levels exceeding 5.5 mEq/L in adults or 6 mEq/L in children with rapidly progressive signs and symptoms of digoxin toxicity.


Warnings and Precautions


Suicidal ingestion may result from more than one drug. Consider toxic effects of other drugs or poisons in cases where signs and symptoms of digitalis toxicity are not relieved by administration of DIGIFab.

Rapid drop in serum potassium concentration may occur after treatment. Monitor frequently.

Patients with poor cardiac function may deteriorate secondary to the withdrawal of the inotropic action of digoxin by DIGIFab. Monitor frequently and provide additional inotropic support if needed. Postpone re-digitalization, if possible, until the Fab fragments have been eliminated; this may require several days or a week or longer in patients with impaired renal function.

Hypersensitivity Reactions

Anaphylaxis and hypersensitivity reactions are possible. Carefully monitor patients for signs and symptoms of an acute allergic reaction and if one occurs, stop the infusion and treat immediately with appropriate emergency medical care.

Patients with known allergies to sheep protein or those who have previously received intact ovine antibodies or Fab are particularly at risk for an anaphylactic reaction.

Do not administer DIGIFab to patients with a known history of hypersensitivity to papaya or papain unless the benefits outweigh the risks and appropriate management for anaphylactic reactions is readily available.

Use of DIGIFab in Renal Failure

The elimination half-life of DIGIFab in renal failure has not been clearly defined. Monitor patients with severe renal failure who receive DIGIFab for a prolonged period for possible recurrence of toxicity. Monitoring of free (unbound) digoxin concentrations after the administration may be appropriate.

Laboratory Tests

DIGIFab may interfere with digitalis immunoassay measurements. Thus, standard serum digoxin concentration measurements may be clinically misleading until the Fab fragments are eliminated from the body. This may take several days or a week or more in patients with markedly impaired renal function. If possible, obtain serum digoxin samples before DIGIFab administration to establish the level of serum digoxin at the time of diagnosis.

The total serum digoxin concentration may rise precipitously following administration of DIGIFab, but this will be almost entirely bound to the Fab fragment and not able to react with receptors in the body.

Adverse Reactions

The most common adverse reactions (>7%) related to DIGIFab administration are worsening congestive heart failure (13%), hypokalemia (13%) and worsening atrial fibrillation (7%).

Please see full Prescribing Information.