Antidotes for acute cardenolide (cardiac glycoside) poisoning

Availability of antidotes for the treatment of acute poisoning in Queensland public hospitals

“…It is indicated in the management of patients with toxicity related to digoxin, digitoxin and all natural cardiac glycosides, including oleander and toad venom. 4,5 Although digibind efficacy is not confirmed by randomised controlled trials, observational data suggest that a treatment response is expected in at least 90% of patients with severe digitalis poisoning. 6 Despite the requirement for timely access to antidotes, studies in several countries demonstrate insufficiencies in antidote availability.…”

Environmental Toxins and the Heart

“…174 While initial symptoms may show up within minutes after ingestion, prolonged hospitalization and observation are recommended after cardenolide ingestion, since the occurrence of dangerous dysrhythmias may be delayed up to 72 hours after ingestion. 173 A meta-analysis of the possible treatments concluded that multiple doses of activated charcoal within 24 hours of toxin ingestion and administration of antidigoxin Fab antitoxin reduces the risk of cardiac dysrhythmias. 173 Hemodialysis or hemoperfusion are not effective against toxicity because of the large volume of distribution of the toxin.…”

“…173 A meta-analysis of the possible treatments concluded that multiple doses of activated charcoal within 24 hours of toxin ingestion and administration of antidigoxin Fab antitoxin reduces the risk of cardiac dysrhythmias. 173 Hemodialysis or hemoperfusion are not effective against toxicity because of the large volume of distribution of the toxin. 180 …”

Dogbane Family and Cardenolides

“…41 Several case reports document the use of Fab fragments following oleander toxicity, but the effi cacy of the Fab fragments in these cases is unclear. 41 Several case reports document the use of Fab fragments following oleander toxicity, but the effi cacy of the Fab fragments in these cases is unclear.…”