Digitoxin

Medicinal plants containing cardiac glycosides were known to the ancient Egyptians 3000 years ago, but these agents were used randomly and with variable success until the 18th century, when William Withering an English physician and botanist, published a monograph describing the clinical effects of an extract of the foxglove plant i.e., Digitalis purpurea in 1785, described in detail the indication for use of cardiacglycoside. Digitoxin is a cardiac glycoside obtained from Digitalis purpurea and other suitable species of of Digitalis, containing 3 molecules of digitxose linked to digitoxigenin. It has both lipophilic (steroid nucleus) and hydrophilic (lactone ring, hydroxyl, sugar) groups. It makes the heart function more efficient. It increases the force of contraction of heart and slows heart rate, used to treat congestive heart failure, to control ventricular rate in the treatment of supraventricular dysrhythmias including atrial fibrillation and flutter, and to treat paroxysmal atrial tachycardia. Digitoxin is administered orally, intramuscularly or intravenously.

Brands
Adult Dose
Dose: 1.5 to 2 ug/kg
Single Dose: 1.8 (1.75)
Frequency: 24 hourly
Route: PO
Instructions: Maintenance, As Required
Neonatal
Paedriatic
Dose: 20 ug/kg
Single Dose: 20 (20)
Frequency: As recommended.
Route:
Instructions:
Characteristics
Crystodigin is the derivative of Digitoxin. It is of Natural origin and belongs to Glycoside. It belongs to Sodium Potassium atpase inhibitor pharmacological group on the basis of mechanism of action and also classified in Cardiac Glycosides and Anti arrhythmic agents pharmacological group.The Molecular Weight of Digitoxin is 764.90. Its pKa is unionized.
Contraindications
Digitoxin is contraindicated in conditions like Heart block,Obstructive cardiomyopathy,Wolf-parkinson-white syndrome,Myocarditis,Congestive cardiomyopathies,Constrictive pericarditis,Chronic cor pulmonale,Aortic valve disease.
Effects
The severe or irreversible adverse effects of Digitoxin, which give rise to further complications include Thrombocytopenia, Hypersensitivity reactions, Ventricular tachycardia, Ventricular fibrillation, Supraventricular extra beats, Sinus bradycardia, Heart block, Gynacomastia, Color vision disturbance.Digitoxin produces potentially life-threatening effects which include Cardiac arrhythmias. which are responsible for the discontinuation of Digitoxin therapy.The signs and symptoms that are produced after the acute overdosage of Digitoxin include Ventricular arrhythmias, Heart block, Hyperkalemia.The symptomatic adverse reactions produced by Digitoxin are more or less tolerable and if they become severe, they can be treated symptomatically, these include Dizziness, Drowsiness, Nausea, Vomiting, Anorexia, Restlessness, Nervousness, Confusion, GI symptoms, Agitation, Amnesia, Delirium, PR interval prolongation, nervousness.
Indications
Digitoxin is primarily indicated in conditions like Acute left ventricular failure, Atrial fibrillation, Atrial flutter, Chronic left ventricular failure, Congestive heart failure, Heart failure, Ischaemic heart disease, Supraventricular arrhythmias (particularly atrial fibrillation), Supraventricular tachycardia.
Interactions
Digitoxin is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAminoglutethimideMetabolism of digitoxin accelerated (reduced effect).Brimonidine (Tartrate)CalciumLarge intravenous doses of calcium salts can precipitate arrhythmias when given with cardiac glycosides (e.g Digitoxin).Carbenoxolone (Na)CertoparinCharcoal (Activated)CholestyramineEsmololFluoxetine (HCl)IsoniazidItopride (HCl)Metacycline (HCl)MetipranololInfrequent reports of METIPRANOLOL [EYE] increasing the NEGATIVE CHRONOTROPIC effect of DIGITOXIN. ModerateMay need to avoid combinationMetoclopramide (HCl)PhenobarbitonePhenobarbitonePhenytoin (Na)Propranolol (HCl)Rauwolfia ReserpineRhubarbRhubarb may increase the toxic effects of Digitoxin.ModerateRifampicinRifampicinSpironolactoneVerapamil (HCl)VORICONAZOLEVoriconazole may increase the serum concentration of digitoxin by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of digitoxin if voriconazole is initiated, discontinued or dose changed. These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.
Interfrence
No well documented
Risks
Drug should not be given to Paediatrics, Pregnant Mothers, Geriatrics, and Neonates.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.
Storage
Tab Store Below 40°C. Protect from Sunlight and Moisture.
Warnings
Digitoxin should be used with caution in patients with history of liver, kidney, thyroid or lung diseases. If patient have ever had rheumatic fever. Food high in fiber may decrease the absorption of digitoxin, be sure to take digitoxin a few hours before or after eating something high in fiber (such as bran). If normal activity causes shortness of breath or if patient awakens frequently during the night due to shortness of breath, tell the doctor. Do not change the dose without consulting the doctor. Before having surgery, including dental surgery, tell the doctor about the use of digitoxin. This medication should be used only when clearly needed during pregnancy or lactation.
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