Anti-digoxin Fab fragments in cardiotoxicity induced by ingestion of yellow oleander: a randomised controlled trial

Eddleston, Michael; Rajapakse, Senaka; Rajakanthan,; Jayalath, S; Sjostrom, Lena; Santharaj, Wijeyasingam; Thenabadu, P. N.; Sheriff, M H Rezvi; Warrell, D. A.

doi:10.1016/s0140-6736(00)90014-x

Cited by 153 publications

(64 citation statements)

References 29 publications

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“…Given the occasional nature of NO intoxication, there is no treatment supported by a strong evidence in the literature. Few randomised-controlled trials are actually available [8][9][10] and all of them addressed poisoning by Yellow Oleander (Thevetia peruviana) that contains slightly different cardiac glycosides from NO, commonly used for deliberate selfpoisoning in Sri Lanka. 11 Actually, intoxication from common or yellow oleander is managed in the same way.…”

Section: Discussionmentioning

confidence: 99%

“…16 These antibodies can also bind to oleandrin in vitro and reduce its active concentration. 17 A randomised controlled trial by Eddleston et al 9 addressed the use of 1200 mg of intravenous Fab antibodies for life-threatening cardiac arrhythmias in patients with yellow oleander poisoning, reporting a highly significant response to treatment. Alternatively, 400 mg in 20 minutes followed by an infusion of 400-800 mg over 6-8 hours has also been suggested.…”

Section: Discussionmentioning

confidence: 99%

“…5 In case of advanced AV block, severe sinus node block and ventricular tachyarrhythmia, administration of anti-digoxin Fab is appropriate in patients with oleander poisoning, independently from serum digoxin concentration, as routinely used digoxin assays are at best semiquantitative for other digoxin-like substances. 9,18,19 Hyperkalaemia (serum potassium >5.5 mEq/L) could also be an indication for Fab administration in oleander poisoning, as the antibodies decrease potassium concentrations significantly within 2 hours.…”

Section: Discussionmentioning

confidence: 99%

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Severe symptomatic bradycardia after a dinner of spicy oleander soup

Tampieri¹,

Mucci²,

Palmonari³

et al. 2016

Emerg Care J

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Cardiac glycosides similar to digoxin are produced by different plants in nature. Nerium oleander, commonly grown as an ornamental shrub, can be found worldwide in temperate countries. Intentional or accidental ingestion of any part of the plant can lead to clinically relevant intoxication. A 63-year-old woman came to the emergency department with acute dyspeptic symptoms after eating vegetable soup flavored with unfamiliar flowers she have collected herself. However, the electrocardiography (ECG) showed abnormalities that raised suspicions for an overdose of digoxin-like cardiac glycosides. The patient was not on treatment with digoxin and a careful anamnesis revealed that she had eaten oleander leaves. Digoxin specific Fab antibody fragments were administered for marked bradycardia that was not responding to atropine administration, after counseling with the reference toxicology center. The patient was also treated with activated charcoal and magnesium sulphate, intravenous fluids and pantoprazole. Four days later she was discharged as asymptomatic, with normal sinus rhythm. Emergency physicians should be aware of this type of poisoning, especially in cases with typical ECG alterations in patients not treated with digoxin and medical history of plants ingestion. Cardio-active glycosides are present in different plants, often used inappropriately, with potential toxic effects and harmful drug interactions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Severe symptomatic bradycardia after a dinner of spicy oleander soup

Tampieri¹,

Mucci²,

Palmonari³

et al. 2016

Emerg Care J

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show abstract

“…A randomized controlled trial involving 66 patients with cardiac glycoside toxicity from ingestion of yellow oleander in Sri Lanka found that digoxin-Fab resulted in a significant resolution of dysrhythmias and hyperkalemia compared with saline placebo. 9 Several other observational studies have reported favourable outcomes with use of digoxin-Fab in cases of plant-related cardiac glycoside poisonings. 10 Dosing recommendations for symptomatic non digoxin cardiac glycoside exposure suggest empiric administration of 10 vials of digoxin-Fab.…”

Section: Managementmentioning

confidence: 98%

Two cases of cardiac glycoside poisoning from accidental foxglove ingestion

Janssen

Berg

Ovakim

2016

CMAJ

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“…To bind cardiac glycosides and to reduce active concentrations, the use of digoxin-specific antibody fragments has been proposed in many publications of severe glycoside poisoning. 2 Indications were the same as in digitalis intoxication. 3 In our case, because of the lack of criteria indicating severity, such treatment was not considered.…”

mentioning

confidence: 99%