Digitoxin

Digitoxin
Systematic (IUPAC) name
(3β,5β)-3-[(O-2,6-dideoxy- β-D-ribo-hexapyranosyl-(1->4)- 2,6-dideoxy-β-D-ribo-hexopyranosyl)oxy]- 14-hydroxycard-20(22)-enolide
Identifiers
CAS number	71-63-6
ATC code	C01AA04
PubChem	11968425
Chemical data
Formula	C41H64O13
Mol. mass	764.939 g/mol
Pharmacokinetic data
Bioavailability	95% (Oral)
Metabolism	Liver
Half life	5~7 days
Excretion	?
Therapeutic considerations
Pregnancy cat.	?
Legal status
Routes	?

Digitoxin is a cardiac glycoside. It has similar structure and effects to digoxin (though the effects are longer-lasting). Unlike digoxin (which is eliminated from the body via the kidneys), it is eliminated via the liver, so could be used in patients with poor or erratic kidney function. However, it is now rarely used in current UK medical practice. While there have been several controlled trials which have shown digoxin to be effective in a proportion of patients treated for heart failure, there is not the same strong evidence base for digitoxin, although it is presumed to be similarly effective.

Toxicity

Digitoxin exhibits similar toxic effects to the more-commonly used digoxin, namely: anorexia, nausea, vomiting, diarrhea, confusion, visual disturbances, and cardiac arrhythmias. Anti-digoxin antibody fragments, the specific treatment for digoxin poisoning, are also effective in serious digitoxin toxicity.

References

• Johansson S, Lindholm P, Gullbo J, Larsson R, Bohlin L, Claeson P (2001). "Cytotoxicity of digitoxin and related cardiac glycosides in human tumor cells". Anticancer Drugs 12 (5): 475–83. doi:10.1097/00001813-200106000-00009. PMID 11395576. 
• Hippius M, Humaid B, Sicker T, Hoffmann A, Göttler M, Hasford J (2001). "Adverse drug reaction monitoring--digitoxin overdosage in the elderly". Int J Clin Pharmacol Ther 39 (8): 336–43. PMID 11515708. 
• Belz G, Breithaupt-Grögler K, Osowski U. "Treatment of congestive heart failure--current status of use of digitoxin". Eur J Clin Invest 31 Suppl 2: 10–7. PMID 11525233. 
• Haux J, Klepp O, Spigset O, Tretli S (2001). "Digitoxin medication and cancer; case control and internal dose-response studies". BMC Cancer 1: 11. doi:10.1186/1471-2407-1-11. PMID 11532201. 
• Srivastava M, Eidelman O, Zhang J, Paweletz C, Caohuy H, Yang Q, Jacobson K, Heldman E, Huang W, Jozwik C, Pollard B, Pollard H (2004). "Digitoxin mimics gene therapy with CFTR and suppresses hypersecretion of IL-8 from cystic fibrosis lung epithelial cells". Proc Natl Acad Sci USA 101 (20): 7693–8. doi:10.1073/pnas.0402030101. PMID 15136726. 

External links

• "Comparing the Toxicity of Digoxin and Digitoxin in a Geriatric Population: Should an Old Drug Be Rediscovered?"