Management overview for acute digoxin poisoning

Note: Urgently contact a clinical toxicologist or poisons information centre if acute digoxin poisoning is suspected.

This monograph discusses the management of acute digoxin poisoning, which refers to the acute ingestion of a toxic dose of digoxin. For management of chronic accumulation of digoxin, see here.

Acute digoxin poisoning is rare. Digoxin’s therapeutic effects and toxicity are mediated by blockade of the sodium-potassium adenosine triphosphatase (ATPase) pump. In poisoning, digoxin causes cardiovascular toxicity and hyperkalaemia, but onset is delayed by hours while the drug is being distributed into the myocardium and other tissues.

Certain plants (eg foxglove, oleander) and animals (eg cane toads) produce digoxin-like compounds that cause similar toxicity to digoxin when ingested. Suspected acute poisoning with digoxin-like compounds (eg cardiac glycoside–containing plants) are managed as for acute digoxin poisoning.

If acute digoxin poisoning is suspected, urgently contact a clinical toxicologist or poisons information centre (13 11 26). Management of acute digoxin poisoning involves:

  • providing early gastrointestinal decontamination with activated charcoal if possible
  • close monitoring for, and treatment of, cardiovascular complications (life-threatening arrhythmias and myocardial depression)
  • giving titrated digoxin-specific immune antibody fragments (digoxin immune Fab) if indicated
  • treating hyperkalaemia.