Digitoxin

Digitoxin is a cardiac glycoside. It is a phytosteroid and is similar in 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 Western medical practice. While several controlled trials have shown digoxin to be effective in a proportion of patients treated for heart failure, the evidence base for digitoxin is not as strong, although it is presumed to be similarly effective.[1]

Not to be confused with Digoxin.
Digitoxin
Clinical data
Trade namesDigitaline
ATC code
Pharmacokinetic data
Bioavailability95% (Oral)
MetabolismLiver
Elimination half-life5~7 days
Identifiers
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.000.691
Chemical and physical data
FormulaC41H64O13
Molar mass764.950 g·mol−1
3D model (JSmol)
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Toxicity

Digitoxin exhibits similar toxic effects to the more commonly used digoxin, namely: anorexia, nausea, vomiting, diarrhea, confusion, visual disturbances, and cardiac arrhythmias. Antidigoxin antibody fragments, the specific treatment for digoxin poisoning, are also effective in serious digitoxin toxicity.[2]

History

The first description of the use of foxglove dates back to 1775.[3] For quite some time, the active compound was not isolated. Oswald Schmiedeberg was able to obtain a pure sample in 1875. The modern therapeutic use of this molecule was made possible by the works of the pharmacist and the French chemist Claude-Adolphe Nativelle (1812-1889). The first structural analysis was done by Adolf Otto Reinhold Windaus in 1925, but the full structure with an exact determination of the sugar groups was not accomplished until 1962.[4][5]

Use

Use in fiction

Digitoxin is used as a poison or murder weapon in:

  • Agatha Christie's Appointment with Death
  • Elizabeth Peters' Die For Love
  • CSI, season 9, episode 19: "The Descent of Man"
  • Rosewood season 2, episode 20: Calliphoridae and Country Roads
  • "Casino Royale" (2006)
  • "Uneasy Lies the Crown" on Columbo, season 9, episode 5 (1990)
  • "Affair of the Heart" on McMillan and Wife, season 6, episode 5 (1977)
  • Murder 101: "College can be a Murder"
  • Several episodes of Murder She Wrote.

In The Decemberists's song, "The Rake's Song" on The Hazards of Love album, the narrator murders his daughter by feeding her foxglove.

Use in cancer chemotherapy

Digitoxin and related cardenolides display potent anticancer activity against a range of human cancer cell lines in vitro but the clinical use of digitoxin to treat cancer has been restricted by its narrow therapeutic index.[6][7] Digitoxin glycorandomization led to the discovery of novel digitoxigenin neoglycosides which displayed improved anticancer potency and reduced inotropic activity (the perceived mechanism of general toxicity).[8] Steroidal glycosides based upon this latter discovery served as the basis for the development of a new class of antibody-drug conjugate known as extracellular drug conjugates (EDCs) as first in class agents to treat cancer by the biotechnology company Centrose.

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References
  1. Belz GG, Breithaupt-Grögler K, Osowski U (2001). "Treatment of congestive heart failure--current status of use of digitoxin". European Journal of Clinical Investigation. 31 Suppl 2 (Suppl 2): 10–7. doi:10.1046/j.1365-2362.2001.0310s2010.x. PMID 11525233. Archived from the original on 2013-01-05.
  2. Kurowski V, Iven H, Djonlagic H (1992). "Treatment of a patient with severe digitoxin intoxication by Fab fragments of anti-digitalis antibodies". Intensive Care Medicine. 18 (7): 439–42. doi:10.1007/BF01694351. PMID 1469187.
  3. Withering W (1785). An Account of the Foxglove and Some of its Medical Uses: With Practical Remarks on Dropsy and other Diseases. Classics of Medicine Library.
  4. Diefenbach WC, Meneely JK (May 1949). "Digitoxin; a critical review". The Yale Journal of Biology and Medicine. 21 (5): 421–31. PMC 2598854. PMID 18127991.
  5. Sneader W (2005). Drug discovery: A history. p. 107. ISBN 978-0-471-89980-8.
  6. Menger L, Vacchelli E, Kepp O, Eggermont A, Tartour E, Zitvogel L, et al. (February 2013). "Trial watch: Cardiac glycosides and cancer therapy". Oncoimmunology. 2 (2): e23082. doi:10.4161/onci.23082. PMC 3601180. PMID 23525565.
  7. Elbaz HA, Stueckle TA, Tse W, Rojanasakul Y, Dinu CZ (April 2012). "Digitoxin and its analogs as novel cancer therapeutics". Experimental Hematology & Oncology. 1 (1): 4. doi:10.1186/2162-3619-1-4. PMC 3506989. PMID 23210930.
  8. Langenhan JM, Peters NR, Guzei IA, Hoffmann FM, Thorson JS (August 2005). "Enhancing the anticancer properties of cardiac glycosides by neoglycorandomization". Proceedings of the National Academy of Sciences of the United States of America. 102 (35): 12305–10. Bibcode:2005PNAS..10212305L. doi:10.1073/pnas.0503270102. PMC 1194917. PMID 16105948.

Further reading

Media related to Digitoxin at Wikimedia Commons

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