Digitalis

 Risk Factor: C
 Class: CARDIOVASCULAR DRUGS / Cardiac Drugs

Contents of this page:

Fetal Risk Summary
Breast Feeding Summary
References
Questions and Answers

Fetal Risk Summary

No reports linking digitalis or the various digitalis glycosides with congenital defects have been located. Animal studies have failed to show a teratogenic effect (1).

Rapid passage to the fetus has been observed after digoxin and digitoxin (2,3,4,5,6,7,8 and 9). One group of investigators found that the amount of digitoxin recovered from the fetus was dependent on the length of gestation (2). In the late 1st trimester, only 0.05%0.10% of the injected dose was recovered from three fetuses. Digitoxin metabolites accounted for 0.18%0.33%. At 34 weeks of gestation, digitoxin recovery was 0.85% and metabolite recovery was 3.49% from one fetus. Average cord concentrations of digoxin in three reports were 50%, 81%, and 83% of the maternal serum (3,4,9). The highest fetal concentrations of digoxin in the second half of pregnancy were found in the heart (5). The fetal heart has only a limited binding capacity for digoxin in the first half of pregnancy (5). In animals, amniotic fluid acts as a reservoir for digoxin, but no data are available in humans after prolonged treatment (5). The pharmacokinetics of digoxin in pregnant women have been reported (10,11).

Digoxin has been used for both maternal and fetal indications (e.g., congestive heart failure and supraventricular tachycardia) during all stages of gestation without causing fetal harm (12,13,14,15,16,17,18,19,20,21,22,23,24 and 25). Direct administration of digoxin to the fetus by periodic IM injections has been used to treat supraventricular tachycardia when indirect therapy via the mother failed to control the arrhythmia (26).

In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 34 newborns had been exposed to digoxin during the 1st trimester (F. Rosa, personal communication, FDA, 1993). One (2.9%) major birth defect was observed (one expected), an oral cleft. Although the number of exposures is small, these data are supportive of previous experience for a lack of association between the drug and congenital defects.

Fetal toxicity resulting in neonatal death has been reported after maternal overdose (27). The mother, in her 8th month of pregnancy, took an estimated 8.9 mg of digitoxin as a single dose. Delivery occurred 4 days later. The baby demonstrated digitalis cardiac effects until death at age 3 days from prolonged intrauterine anoxia.

In a series of 22 multiparous patients maintained on digitalis, spontaneous labor occurred more than 1 week earlier than in 64 matched controls (28). The first stage of labor in the treated patients averaged 4.3 hours vs. 8 hours in the control group. In contrast, others found no effect on duration of pregnancy or labor in 122 patients with heart disease (29).

Breast Feeding Summary

Digoxin is excreted into breast milk. Data for other cardiac glycosides have not been located. Digoxin milk:plasma ratios have varied from 0.60.9 (4,7,30,31). Although these amounts seem high, they represent very small amounts of digoxin due to significant maternal protein binding. No adverse effects in the nursing infant have been reported. The American Academy of Pediatrics considers digoxin to be compatible with breast feeding (32).

References

1. Shepard TH. Catalog of Teratogenic Agents. 3rd ed. Baltimore, MD:Johns Hopkins University Press, 1980:1167.
2. Okita GT, Plotz EF, Davis ME. Placental transfer of radioactive digitoxin in pregnant women and its fetal distribution. Circ Res 1956;4:37680.
3. Rogers MC, Willserson JT, Goldblatt A, Smith TW. Serum digoxin concentrations in the human fetus, neonate and infant. N Engl J Med 1972;287:10103.
4. Chan V, Tse TF, Wong V. Transfer of digoxin across the placenta and into breast milk. Br J Obstet Gynaecol 1978;85:6059.
5. Saarikoski S. Placental transfer and fetal uptake of 3H-digoxin in humans. Br J Obstet Gynaecol 1976;83:87984.
6. Allonen H, Kanto J, Lisalo E. The foeto-maternal distribution of digoxin in early human pregnancy. Acta Pharmacol Toxicol 1976;39:47780.
7. Finley JP, Waxman MB, Wong PY, Lickrish GM. Digoxin excretion in human milk. J Pediatr 1979;94:33940.
8. Soyka LF. Digoxin: placental transfer, effects on the fetus, and therapeutic use in the newborn. Clin Perinatol 1975;2:2335.
9. Padeletti L, Porciani MC, Scimone G. Placental transfer of digoxin (beta-methyl-digoxin) in man. Int J Clin Pharmacol Biopharm 1979;17:823.
10. Marzo A, Lo Cicero G, Brina A, Zuliani G, Ghirardi P, Pardi G. Preliminary data on the pharmacokinetics of digoxin in pregnancy. Boll Soc Ital Biol Sper 1980;56:21923.
11. Luxford AME, Kellaway GSM. Pharmacokinetics of digoxin in pregnancy. Eur J Clin Pharmacol 1983;25:11721.
12. Lingman G, Ohrlander S, Ohlin P. Intrauterine digoxin treatment of fetal paroxysmal tachycardia: case report. Br J Obstet Gynaecol 1980;87:3402.
13. Kerenyi TD, Gleicher N, Meller J, Brown E, Steinfeld L, Chitkara U, Raucher H. Transplacental cardioversion of intrauterine supraventricular tachycardia with digitalis. Lancet 1980;2:3934.
14. Harrigan JT, Kangos JJ, Sikka A, Spisso KR, Natarajan N, Rosenfeld D, Leiman S, Korn D. Successful treatment of fetal congestive heart failure secondary to tachycardia. N Engl J Med 1981;304:1527-9.
15. Diro M, Beydoun SN, Jaramillo B, O'Sullivan MJ, Kieval J. Successful pregnancy in a woman with a left ventricular cardiac aneurysm: a case report. J Reprod Med 1983;28:55963.
16. Heaton FC, Vaughan R. Intrauterine supraventricular tachycardia: cardioversion with maternal digoxin. Obstet Gynecol 1982;60:74952.
17. Simpson PC, Trudinger BJ, Walker A, Baird PJ. The intrauterine treatment of fetal cardiac failure in a twin pregnancy with an acardiac, acephalic monster. Am J Obstet Gynecol 1983;147:8424.
18. Spinnato JA, Shaver DC, Flinn GS, Sibai BM, Watson DL, Marin-Garcia J. Fetal supraventricular tachycardia: in utero therapy with digoxin and quinidine. Obstet Gynecol 1984;64:7305.
19. Bortolotti U, Milano A, Mazzucco A, Valfre C, Russo R, Valente M, Schivazappa L, Thiene G, Gallucci V. Pregnancy in patients with a porcine valve bioprosthesis. Am J Cardiol 1982;50:10514.
20. Rotmensch HH, Rotmensch S, Elkayam U. Management of cardiac arrhythmias during pregnancy: current concepts. Drugs 1987;33:62333.
21. Tamari I, Eldar M, Rabinowitz B, Neufeld HN. Medical treatment of cardiovascular disorders during pregnancy. Am Heart J 1982;104:135763.
22. Dumesic DA, Silverman NH, Tobias S, Golbus MS. Transplacental cardioversion of fetal supraventricular tachycardia with procainamide. N Engl J Med 1982;307:112831.
23. Gleicher N, Elkayam U. Cardiac problems in pregnancy. II. Fetal aspects: advances in intrauterine diagnosis and therapy. JAMA 1984;252:7880.
24. Golichowski AM, Caldwell R, Hartsough A, Peleg D. Pharmacologic cardioversion of intrauterine supraventricular tachycardia. A case report. J Reprod Med 1985;30:13944.
25. Reece EA, Romero R, Santulli T, Kleinman CS, Hobbins JC. In utero diagnosis and management of fetal tachypnea. A case report. J Reprod Med 1985;30:2214.
26. Weiner CP, Thompson MIB. Direct treatment of fetal supraventricular tachycardia after failed transplacental therapy. Am J Obstet Gynecol 1988;158:5703.
27. Sherman JL Jr, Locke RV. Transplacental neonatal digitalis intoxication. Am J Cardiol 1960;6:8347.
28. Weaver JB, Pearson JF. Influence of digitalis on time of onset and duration of labour in women with cardiac disease. Br Med J 1973;3:51920.
29. Ho PC, Chen TY, Wong V. The effect of maternal cardiac disease and digoxin administration on labour, fetal weight and maturity at birth. Aust NZ J Obstet Gynaecol 1980;20:247.
30. Levy M, Granit L, Laufer N. Excretion of drugs in human milk. N Engl J Med 1977;297:789.
31. Loughnan PM. Digoxin excretion in human breast milk. J Pediatr 1978;92:101920.
32. Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:13750.
    
    

Questions and Answers

Do I have to worry about planting Camelot Digitalis in my garden? Are they toxic?, Someone told me that I shouldn't have planted the Digitalis because I have to be careful how I handle it. I know that digitalis is used in part for heart medication, but should I worry about having them in my garden for any reason? Is this person justs yanking my chain?

as beautiful as they are, they need special attention if they're in your garden....

when 'just a nibble of one of the upper leaves can cause death', it's not something you want a lot of if you have kids and pets.....

read here, under toxicity....

http://en.wikipedia.org/wiki/Digitalis

Is a foxglove or digitalis purpurea any herb?, What herbs are foxgloves? Or is foxglove the name of the herb?

It was used as an herbal heart medicine for generations, but is now a prescription drug.
To try to use the plant as herbal medicine is VERY dangerous. It can kill if only a bit too much is consumed.

how do I care for digitalis camelot?, I have 4 digialis camelot white plants in my flower bed. They are all drooping and looking really bad. These are new plants, are the just not tolerating the change, should I prune them, more water? I just don't know and I cannot find anything on the internet.

Digitalis do not do well in full sun. That may or may not be an issue for you. The drooping thing sounds like lack of water, and if you just planted them and if they were root bound they will need water to get established. They may or may not send up more flower shoots if you cut them back, but the blooms demand a lot of water and removing the blooms can save overly-stressed plants.
I would try watering them every day or every other day, depending upon the weather and temperature you have, and try cutting them back as a last resort.
Hope that helps.......

Can Foxglove/Digitalis, Marigold, and Lily of the Valley survive a Midwest winter potted outside?,

Foxglove is a biennial and it might come back next year- but through its seeds Marigold will not come back. Lily of the Valley is a perennial and might come back next year- depends on how long the roots are frozen for. Your best bet is planting the Lily of the Valley in the ground and the foxglove in the ground for the best chances of them coming back.

How do you kill digitalis growing in your backyard , it has overgrown and I can't grow grass.?,

It is also highly poisonous. The common name is called foxglove.

Your best bet is to purchase a weed killer from one of your local garden centers or home improvement stores. There are many on the market. Spectracide markets one called "Triple Strike" and Ortho has one, logically enough called "Weed-B-Gon".

Both producuts are systemic, meaning they work all the way down to the roots killing the plant entirely. It will not work on plants that have yet to germinate, though. Foxglove is propagated by seed, so you can either wait until the seedlings pop up and zap them with the weed killer then or use yet another product called "Preen" which stops the germination process of seeds.

Or, use both.

You cannot plant grass seed and use Preen at the same time.

Is the Foxglove Digitalis plant poisonous?, Is it safe to plant them in the garden if you have pets?

Foxglove is indeed quite poisonous. Every part of it is poisonous, from the stem to the leaves to the flower. Even a little bit can cause death. If you have pets that you think may nibble at your foxglove, don't plant this in your garden.

How do you extract the digitalis from the fox glove?, Has anyone tried this?

Digitalis is a chemical known as an alkaloyd. These nitrogen containing substances are what many pharmaceuticals are based on. One of their characteristic properties is how their soluability is affected by pH. In acid environments they form alkaloyd salts and are water soluable. In a basic environment they are nonpolar compounds and are soluable in nonpolar solvents. Extraction involves exposing dried plant material to a basic solution of Sodium or Potassium hydroxide in a separatory funnel. To this is added a nonpolar solvent like hexane or petroleum ether. The alkaloys will pass from the water into the nonpolar solvent. The solvent is separated and when evaporated, the alkaloyds remain as a sticky white substance. Alkaloyds are characterized by a bitter taste. Most of these compounds have either stimulatory or sedative effects on the central nervous system and can be toxic in large doses. Digitalis itself is used as a heart stimulant.

Can the heart medicine digitalis, that nearly killed James Bond stop your heart in real life?, I know that it is a medicine used to treast heart failure so I think it is unlikely.

Toxic levels of digitalis are indeed fatal.

Fortunately, "Digibind" and "Digifab" are effective treatments when given early.

how to grow digitalis?, what do you do after it finishes blooming

Digitalis is a biennial that grows a rosette cluster first year and then the second year it flowers and set seeds and dies off. Ocasionally you'l get 3yr to 4yr old plants. You collect the seeds when the pods dry out and plant them in the wanted area in fall for next spring you'll get flowers the year after next year or you can let the plant drop seeds wherever it wishes.
However there is one called theDigitalis mertonensis: Strawberry Foxglove that is perennial it comes back every year but let a few sow to ensure you'll have a supply.