Digitalis: The flower, the drug, the poison

Although used as a heart drug today, Withering used digitalis for a wide variety of ailments, including anasarca (generalized edema), epilepsy, hydrothorax (fluid in the pleural cavities), ovarian dropsy, and phthisis pulmonalis (probably tuberculosis). Sometimes Withering used digitalis as a treatment of last resort, "...whilst I was less expert in the management of the Digitalis, I seldom prescribed it, but when the failure of every other method compelled me to do it... if the properties of that plant had not been discovered, by far the greatest part of these patients would have died."

Digoxin: The good and the bad

After 230 years of use, digitalis remains an important and useful therapy for patients with atrial fibrillation, heart failure, and the 30-50 % of patients with both conditions. Although the combination of positive inotropic activity with negative chronotropic effects has been shown to reduce hospital admissions in heart failure, there is a distinct lack of robust trial data, particularly in patients with atrial fibrillation.

Management of Digoxin Toxicity

Although the overall prevalence of digoxin toxicity seems to be decreasing, one must think of this toxicity when facing a patient with bradycardia and “something else”

Case for retiring its use in elderly patients?

Digoxin is one of the oldest cardiac medications still in use. Both the current Canadian guidelines for heart failure and atrial fibrillation and the American College of Cardiology Foundation–American Heart Association guideline for the management of heart failure include digoxin as a treatment option. However, it does not have the most favourable efficacy and safety profiles. Digoxin has a complex pharmacokinetic profile, a narrow therapeutic range, and multiple drug interactions.

Digoxin Use in Modern Medicine

Digoxin has been around for centuries, but its use has been limited by several factors. Because of its narrow therapeutic window, digoxin requires close monitoring. Also, two major drawbacks of digoxin are its adverse effects (AEs) and multiple drug interactions. It is considered adjunctive therapy, rather than first-line therapy.

Digoxin, the heart medicine that may have given us Van Gogh’s Starry Night

One of the interesting stories in the history of digoxin is the link with Vincent Van Gogh. Much has been written about the physical and mental health problems that Van Gogh had in his life and numerous diagnoses have been proposed. Van Gogh’s portrait of his physician holding a foxglove plant. fmpgoh/Flickr, CC BY Among these diagnoses is the suspicion that he suffered from digitalis (foxglove) toxicity, which resulted in the frequent use of yellow halos in his paintings due to xanthopsia. This is very evident in paintings such as Starry Night and The Night Café. Supporting this hypothesis is the fact that when Vincent painted his personal physician in the Portrait of Doctor Gachet he was holding the foxglove plant.

It was all yellow: did digitalis affect the way Van Gogh saw the world?

Extracted from foxgloves, digitalis was once used as a treatment for epilepsy. Could a side effect have triggered the artist’s “yellow period”?

New Concerns About an Old Heart Drug

A large new study found that one of the oldest and most commonly used heart medications may shorten the lives of patients with atrial fibrillation, a common type of irregular heartbeat that afflicts about three million Americans. The findings are prompting some experts to warn that the drug should be prescribed less widely. Unlike many prescription drugs, digoxin has never been subjected to a rigorous clinical trial in which the drug is compared with a placebo.

Women healers who were persecuted as witches left a rich legacy for modern medicine

Witch’s brews that modern science believes in Withering hypothesized that the active ingredient in Hutton’s remedy was the foxglove plant. He tested this by administering dried, crushed foxglove leaves to over 160 patients, and wrote up his findings (pdf) in 1785, noting that it was particularly useful for those who had developed scarlet fever or strep throat, which can lead to heart damage when untreated. Today, we know even more details about why Hutton’s remedy worked: digoxin, a compound found in foxglove is still used as the active ingredient in some heart and blood pressure medications.