(Circulation. 1999;99:1265-1270.)
© 1999 American Heart Association, Inc.
Cardiovascular Drugs |
Digitalis
From the Department of Medicine, Division of Cardiology (P.J.H.), Saint Louis University School of Medicine, St. Louis, MO; and the Cardiovascular Division (R.A.K.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
Correspondence to Ralph A. Kelly, MD, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. E-mail rakelly{at}rics.bwh.harvard.edu
Abstract
Abstract—Cardiac
glycosides have played a prominent role in the therapy of congestive
heart failure since William Withering codified their use in his late
18th century monograph on the efficacy of the leaves of the common
foxglove plant (Digitalis purpurea). Despite their
widespread acceptance into medical practice in the ensuing 200
years, both the efficacy and the safety of this class of drugs continue
to be a topic of debate. Moreover, despite the fact that the molecular
target for the cardiac glycosides, the 
-subunit of sarcolemmal
Na+K+-ATPase (or sodium pump) found on most
eukaryotic cell membranes, has been known for several
decades, it remains controversial whether the sympatholytic or positive
inotropic effects of these agents is the mechanism most relevant to
relief of heart failure symptoms in humans with systolic
ventricular dysfunction. Herein, we review the molecular
and clinical pharmacology of this venerable class of drugs, as well as
the manifestations of digitalis toxicity and their treatment. We also
review in some detail recent clinical trials designed to examine the
efficacy of these drugs in heart failure, with a focus on the Digoxin
Investigation Group data set. Although, in our opinion, the data on
balance warrant the continued use of these drugs for the treatment of
symptoms of heart failure in patients already receiving contemporary
multidrug therapy for this disease, the use of digitalis preparations
will inevitably decline with the maturation of newer pharmacotherapies.
Key Words: drugs • digitalis • heart failure • pharmacology
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