Haemoperfusion in the management of digoxin toxicity: is it warranted?

Several recent publications have encouraged the use of hemoperfusion to remove digoxin from the body of overdosed patients. The usefulness of haemoperfusion in removing digoxin from the body has therefore been examined using pharmacokinetic simulation techniques and published data. Haemoperfusion for a period of 4 hours with a clearance of 100 ml/min removes less than 7% of the amount of digoxin in the body (including that in the gastrointestinal tract at the beginning of haemoperfusion), regardless of the time after the dose that haemoperfusion is started. Dramatic therapeutic benefit in digoxin intoxication is unlikely to be a consequence of the amount of digoxin removed from the body by haemoperfusion. If therapeutic benefit is derived from a transient decline of digoxin concentration in plasma, it may be expected to be negated as the drug redistributes from tissues.