Digitalis purpurea (Foxglove)

Family: Scrophulariaceae

Part Used: Root

Active Constituents:

Cardiac glycosides named digitoxin, digoxin and gitoxin.

Medicinal Actions: Cardiac Stimulant

Medicinal Uses:

1.Digitalis has long been used to address cardiac failure. It is no longer commonly used, and is studied because it causes the strongest botanical action on the heart and all other herbs are evaluated in their strength compared with Digitalis.

2.has tannin and need bacteria flora in the patient

3.Felter states that Digitalis is indicated for use with a patient presenting with “weak, rapid and irregular heart action, with a weak, rapid and flaccid pulse. The patient has dyspnea, cough, jugular fullness and edema. They may have ascites with a scanty supply of dark urine, an irritable heart with weak action. In effect, Felter is describing what we call late stage congestive heart failure.

4.Felter identifies three stages in the patient on a continuous increasing dose of digitalis. Stage one, also called the therapeutic stage, the rhythm is slowed and contractility of the heart increases. Diastole is prolonged and the force of systole increases. This first action is secondary to direct action of the herb on the myocardium and to inhibition of the vagus nerve. The patient may then go into the second stage of treatment. This stage is identified as the toxic stage and occurs when the herb is given continuously or given in too high a dose. The ventricle dilates causing erratic occurrence of systole and prolongation of diastole. The atria decrease function and AV heart block occurs. The third stage follows and is called the lethal or extremely toxic stage. There is rapid ventricular action and racing pulse. The ability of the CNS to inhibit heart function is lost and arrhythmia, insufficient circulation, extreme dilation and complete loss of function occur.

5.The drug Digoxin was created because it is the constituent that is most readily excreted and tends to accumulate less than the other isolated constituents of Digitalis. Digoxin has a strong positive inotropic action on the myocardium. In low dose, it has a negative chronotropic action, but as dosage increases it has a positive chronotropic action. Digoxin is commonly used in short-term therapy, intermediate strength glycosides are indicated in longer-term treatment.

Pharmacy:

Digoxin is dosed based on the degree of heart failure and age of the patient. Typical dosage is 12 – 35 mcg/kg body weight. Maintenance daily dose is between 0.25 – 0.5 mg daily. DIGITALIS PLANT OR PLANT EXTRACTS ARE NO LONGER USED.

Toxicity:

Toxicity may develop several hours after ingestion. At first the pulse slows dramatically. If the patient stands it becomes erratic and rapid. They may have nausea, anxiety, salivation, constriction in their head, giddiness, distorted vision, mental disturbance and/or vomiting. The symptoms may last several days and they may not survive. Aconite is an antidote to digitalis poisoning. Other substances like potassium-depleting drugs, quinidine and corticosteroids may predispose a patient to digitalis poisoning Has rapid onset of activity and could become toxic. Heart rate become irratic and pt. Get nauseus and drowsy… vomiting. head feel tight. All digitalis lanata (woolly foxglove) is also toxic tight. Feel high (gitty out of their body) disruption in vision. May get hallucination.

Stays in the body a lot more thus toxic

Aconite is remedy for digitalis poisoning

3 stage of toxicity

1)       therapeutic stage = slow down the rhythm but increase contractility. Thus get strong contraction since optimizing membrane potential and heart ejection fraction…..stage 1 is the stage you want the formula to be

2)       toxic = when given continuously or too high of a dose. Symptoms are prolong diastole, eratic, AV heart mock and paralysis of the atria.

3)       Toxic and need to be hospitalized = rapid ventricular actionà ventricular fibrillationà heart tacchycardia. Heart no longer is able to reply from regulation of the brain.