Use of cholestyramine in three patients with beta-acetyldigoxin, beta-methyldigoxin and digitoxin intoxication

The effect of cholestyramine (8 g every 6 h by oral administration) on glycoside plasma concentrations of three patients with suicidal and accidental digitalis intoxications were studied. During treatment with cholestyramine the plasma concentrations of beta-acetyldigoxin and beta-methyldigoxin declined with half-lives of 20.4 or 30.0 h. These values are significantly shorter than the therapeutic half-lives reported in the literature. The digitoxin plasma concentration decreased with a half-life of 74.5 h during the first 2 days. When the digitoxin plasma level dropped under 40 ng/ml, the half-life increased, similar to the half-life without cholestyramine administration. From these case reports cholestyramine seems to be helpful in managing intoxications with digoxin derivates as well as with digitoxin.