Digoxin immune Fab (ovine) - DIGIFAB intravenous antidote

In severe renal failure, observe for recurrent digitalis toxicity over a prolonged period; free/unbound digoxin may be useful. Total-digoxin assays can remain misleading for days or at least a week when kidney function is markedly impaired. A post-treatment total rise largely reflects Fab-bound digoxin, not active unbound exposure. Obtain a pretreatment sample when possible and monitor ECG, blood pressure and potassium. Follow potassium closely, especially during the first several hours, because reversal can produce rapid hypokalemia. The selected label does not specify a fixed renal observation duration or replacement dose.

Severe renal failure warrants prolonged observation for recurrent digoxin toxicity after DIGIFAB. Free/unbound digoxin may help assess recurrence; standard total-digoxin assays may mislead until Fab clears, potentially a week or longer in markedly impaired renal function. Total concentrations can rise because bound digoxin is measured. Monitor ECG, blood pressure and potassium; potassium can fall rapidly after reversal. The mirror's general paragraph says especially after the first several hours, whereas its laboratory paragraph says during the first several hours. This timing inconsistency is retained for comparison.