How to manage digitalis toxicity
Nov 25, 2025
Source: Cainiu Health
Dr. Sun Lianqing
Introduction
Management of digitalis toxicity generally includes immediately discontinuing digitalis medications, correcting electrolyte imbalances, administering specific antidotes, treating arrhythmias symptomatically, and monitoring vital signs and clinical changes. Once digitalis toxicity is suspected or confirmed, all medications containing digitalis should be stopped immediately to prevent further drug accumulation and worsening of toxic symptoms.
Management of digoxin toxicity generally includes immediate discontinuation of digoxin-containing drugs, correction of electrolyte disturbances, administration of specific antidotes, symptomatic treatment of arrhythmias, and continuous monitoring of vital signs and clinical status. The details are as follows:
1. Immediate discontinuation of digoxin-containing drugs: Once digoxin toxicity is suspected or confirmed, all medications containing digoxin should be stopped immediately to prevent further drug accumulation and worsening of toxic symptoms. This step is crucial for creating a window for subsequent treatment and represents the first priority in managing toxicity.
2. Correction of electrolyte imbalances: Digoxin toxicity is often associated with hypokalemia and hypomagnesemia, which can exacerbate toxic effects. Potassium and magnesium supplements should be administered intravenously or orally to restore electrolyte balance, reduce the drug's toxic effects on myocardial cells, and alleviate symptoms such as arrhythmias.
3. Use of specific antidotes: For patients with severe toxicity—especially those experiencing life-threatening arrhythmias unresponsive to conventional treatments—digoxin-specific antibody fragments (Digoxin Immune Fab) may be used under medical supervision. These antidotes bind to free digoxin in the bloodstream, rapidly reducing its concentration and mitigating toxic effects.
4. Symptomatic management of arrhythmias: Treatment should be tailored to the type of arrhythmia present. For example, lidocaine or similar agents may be used for tachyarrhythmias, while atropine or temporary cardiac pacing may be required for bradyarrhythmias. These interventions help maintain stable cardiac function and circulatory support.
5. Monitoring of vital signs and clinical changes: Continuous monitoring of heart rate, blood pressure, respiration, level of consciousness, and electrocardiogram (ECG) changes is essential. Regular assessment of serum digoxin levels and electrolyte concentrations allows timely evaluation of disease progression and enables adjustments to the treatment plan, helping to prevent serious complications.
Digoxin-containing medications must be taken strictly as prescribed; patients should not adjust the dosage on their own. Regular monitoring of serum drug levels and electrolytes during treatment is necessary to detect abnormalities early. If symptoms suggestive of toxicity—such as nausea, vomiting, or arrhythmias—occur, immediate medical attention is required.
