Balancing Act: Digoxin Antidote Supply and Demand in New South Wales, Australia

This study aims to evaluate the supply and demand of digoxin antibody (Digoxin-Fab) in New South Wales (NSW) hospitals before and after the updated Therapeutic Guidelines (TG) for digoxin poisoning introduced in August 2020. We also aim to propose standardised stocking recommendations for NSW public hospitals.

This retrospective multicentre study analysed data from the New South Wales Poisons Information Centre (NSWPIC) to assess Digoxin-Fab demand, and from the Life Saving Drugs Register (LSDR) to assess supply in NSW hospitals between January 2017 and December 2022.

A total of 166 cases of digoxin poisoning were identified in NSW: 149 chronic cases across 34 hospitals and 17 acute cases across 14 hospitals. Following the updated TG, the proportion of chronic cases where clinical toxicologists advised Digoxin-Fab (either 'immediately' or 'if clinically indicated') decreased from 39.5% to 31.7% (Risk Difference [RD]: 0.08, 95% Confidence Interval [CI]: -0.09 to 0.23, p = 0.39). For acute cases, recommendations decreased from 75% to 60% (RD: 0.15, CI: -0.31 to 0.62, p = 0.60). LSDR data showed NSW hospitals stocked 238 vials in 2018 and 246 in 2020, with uneven distribution. During the study period, two chronic cases and one acute case lacked Digoxin-Fab at the treating hospital when advised.

With few exceptions, Digoxin-Fab supply in NSW hospitals exceeds demand. Based on usage patterns and guideline updates, a more cost-effective and standardised stocking approach is recommended for NSW hospitals.