Send to

Choose Destination
Clin Toxicol (Phila). 2016;54(2):103-14. doi: 10.3109/15563650.2015.1118488.

Extracorporeal treatment for digoxin poisoning: systematic review and recommendations from the EXTRIP Workgroup.

Author information

a Indiana Poison Center, Indiana University Health , Indianapolis , IN , USA ;
b Division of Nephrology , University of Sao Paulo Medical School , Sao Paulo , Brazil ;
c Department of Emergency Medicine , ZNA, Campus Stuivenberg , Antwerpen , Belgium ;
d Department of Nephrology , Verdun Hospital, University of Montreal , Verdun , Canada ;
e Ronald O. Perelman Department of Emergency Medicine, Division of Medical Toxicology , New York University School of Medicine , New York , NY , USA ;
f Department of Medical Biology , Sacré-Coeur Hospital, University of Montreal , Montreal , Canada ;
g Department of Pharmacy and Therapeutics , Center for Clinical Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy , Pittsburgh , PA , USA ;
h Department of Medicine and Emergency Medicine , McGill University Health Centre, McGill University , Montreal , Canada.



The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatments (ECTR) in poisoning. Here, we present our results for digoxin.


After a systematic literature search, clinical and toxicokinetic data were extracted and summarized following a predetermined format. The entire workgroup voted through a two-round modified Delphi method to reach a consensus on voting statements. A RAND/UCLA Appropriateness Method was used to quantify disagreement, and anonymous votes were compiled and discussed in person. A second vote was conducted to determine the final workgroup recommendations.


Out of 435 articles screened, 77 met inclusion criteria. Only in-vitro, animal studies, case reports and case series were identified yielding a very low quality of evidence for all recommendations. Based on data from 84 patients, including six fatalities, it was concluded that digoxin is slightly dialyzable (level of evidence = B), and that ECTR is unlikely to improve the outcome of digoxin-toxic patients whether or not digoxin immune Fab (Fab) is administered. Despite the lack of robust clinical evidence, the workgroup recommended against the use of ECTR in cases of severe digoxin poisoning when Fab was available (1D) and also suggested against the use of ECTR when Fab was unavailable (2D).


ECTR, in any form, is not indicated for either suspected or proven digoxin toxicity, regardless of the clinical context, and is not indicated for removal of digoxin-Fab complex.


Dialysis; dialyzability; digoxin; extracorporeal treatment; poisoning; systematic review

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Taylor & Francis
Loading ...
Support Center