Digoxin overdose

The preferred agent to combat extreme digoxin overdose is... 

Potentially life-threatening digoxin overdose IV Dosage varies according to amount... 

Digoxin Immune Fab (Protherics) Poison antidote, digoxin overdose... 

Berkovitch M, Akilesh MR. Acute digoxin overdose in a newborn with renal failure use of digoxin immune Fab and peritoneal dialysis. TherDrug Monit. 1994 16 531 -533... 

Glyceryl trinitrate overdose should be treated with the patient s head lowered. Other measures include respiration maintenance, use of plasma expanders, and electrolyte balance. Withdrawal of heparin treatment or dose reduction should be performed with the overdose of heparin. Protamine sulfate may be used to reduce severe bleeding. Heparin should be used with caution with glyceryl trinitrate, aprotinine, alcohol, tobacco, and ACE inhibitors. Nifedipine should be used with care when coadministering with immunosuppressants, magnesium salts, tobacco, digoxin, antineoplastics, calcium channel blockers, antihistamines, antifungals, antiepileptics, antiarrhythmics, and alcohol. 

Digoxin crosses the placenta and enters the neonatal circulation (130). It has therefore been used, for example, to improve fetal cardiac function (131). In normal circumstances there seem to be no adverse effects on the neonate, and neonatal plasma concentrations are below those generally considered to be therapeutic. There has been one report of fatal toxicity in the fetus of a woman who took an overdose of digitoxin (132). 

Accidental overdose of digoxin in a 22-month-old boy caused vomiting, lethargy, and dehydration. The plasma digoxin concentration was 12 mg/ml. There was a relative bradycardia of 90/minute and Mobitz type 1 second-degree heart block on the electrocardiogram (158). 

Overdose of digoxin in a neonate caused complete atrioventricular block and cardiogenic shock, which were completely reversed within 4 hours after administration of the first dose of antidigoxin antibody a second dose was given 48 hours later, when first-degree atrioventricular block occurred (180). 

Cardiac dysrhythmias in digitalis overdose should be treated only if they are life-threatening. Phenytoin is probably the treatment of choice for ventricular tachydysrhyth-mias, but lidocaine or a beta-adrenoceptor antagonist, such as propranolol, are options. After an overdose of 300 tablets of digoxin (plasma digoxin concentration 50 ng/ml), recurrent ventricular fibrillation was successfully treated with bretylium tosylate (191). Sinus bradycardia may respond to atropine. 

Hemoperfusion has been used to treat digitalis overdose (SEDA-5, 174) but once a cardiac glycoside has been distributed to the body tissues hemoperfusion is unlikely to be of benefit. For digitoxin, which has a lower apparent volume of distribution than digoxin, charcoal hemoperfusion may be more valuable. 

Two cases have been reported of contamination of plantain (a plant of the genus Plantago) by Digitalis lanata (144). Both patients suffered from serious overdose of cardiac glycosides with toxic serum digoxin concentrations as a result. 

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