Cardiac Glycoside
Generic and Trade Names:
| Deslanoside | Cedilanid-D | |||
| Digoxin | Digoxin, Lanoxin, Lanoxicaps | |||
| Digitoxin | Crystodigin |
Description:
Cardiac glycosides are a group of compounds, of which, digitalis is derived from the plant Digitalis purpurea. The digitalis group of cardiac glycosides contain a sugar and a steroid joined together.
Cardiac glycosides increase the strength of contraction of the heart muscle. When injected or ingested, they will increase blood circulation and alleviate atrial fibrillation. They are therefore used in cases of congestive heart failure.
Cardiac glycosides can be very toxic if taken in excessive amounts. Among these drugs are digitalis, digoxin.
Digitalis is used to prevent congestive heart failure and to correct irregular heartbeat. Digitalis improves blood circulation to the heart tissue and slows the heartbeat down. The cardiac glycoside, digoxin, comes from the leaves of Digitalis lanata.
Nutritional Considerations:
B-complex supplements are sometimes recommended ( notably: B-1 and B-6). (Zangen 1998)
Avoid caffeine. (Brinker 1998)
Take separately from high fiber products, because it can bind with the drug. (Pronsky 1999)
Electrolytes (especially: calcium, magnesium and potassium)should be within normal limits, because low levels can cause drug toxicity. (Pronsky 1999)
Hypocalcemia lowers the drug's effects, while calcium and vitamin D induced hypercalcemia may cause arrhythmias. (Pronsky 1999) (Holt, Landauer, Schwinger, Whang).
Herbal Considerations:
Avoid natural licorice products which may cause hypokalemia (Pronsky 1999).
Excess use of Aloe, Buckthorn, Cascara sagrada, Horsetail, Licorice, Rhubarb, and Senna can cause potassium loss and toxicity with cardiac glycosides. (Brinker 1998)(Blumenthal 1998)
Canadian hemp roots, Grecian foxglove leaves, Lily of the valley roots, Oleander leaves, Pheasant's eye plant, Pleurisy root, Purple foxglove leaves, Squill bulb leaf scales, and Strophanthus seeds, are all considered cardiotonic herbs and should be avoided with digitalis or other cardiac glycoside drugs. (Brinker 1998)
Blue flag root, Buckthorn fruit, Butternut bark, Castor bean oil, Colocynth fruit, Frangula bark, Gamboge bark, Jalap roots, Leptandra root, Mana ash bark, Mayapple root, Wild cucumber fruit, and Yellow dock root, are all considered laxative herbs and should be avoided with cardiac glycoside drugs. (Brinker 1998)
Hawthorn can increase the activity of digitalis. (Brinker 1998)
Heart rhythm may be disturbed by taking Ma Huang in combination with cardiac glycosides. (Blumenthal 1998)
Khella can reduce cardiac glycoside toxicity. (Brinker 1998)
Potassium deficiency can be further accelerated with simultaneous administration of e.g. corticosteroids,(steroid plants) licorice root or caffeine containing herbs, like Cocoa, Cola, Guarana, Horsetail, Mate, and Tea leaves. (Blumenthal 1998) (Brinker 1998)
The German Commission E has noted that sarsaparilla can cause increased absorption of digitalis glycosides, if used together. (Blumenthal 1998)
As cathartic herbs:
boneset, feverfew, hemp, mandrake, milkweed, Oregon grape, pokeroot, rhubarb, senna, Wahoo, and White bryony
- may theoretically increase the intestinal transit time of digitalis glycosides, inhibiting their absorption and cardiac action. Cathartic-induced hypokalemia, however, increases toxicity and potency of absorbed digitalis and potentiates muscle relaxants (Wang, Botzler).
The absorbant nature of mullein, plantain, psyllium or senna, may inhibit absorption of digitalis and other oral drugs. (Blumenthal 1998)
Several herbs with cardiactive ingredients have been listed by Newall:
Herb
Broom, Alkaloids
Calamus
Cereus, Tyramine
Cola, Caffeine
Coltsfoot, Calcium channel blocker
Devil's Claw
Fenugreek
Figwort
Fumitory
Ginger
Ginseng, Panax
Goldenseal, Berberine
Hawthorn, Tyramine
Horehound, White
Lime, Flower
Mate, Caffeine
Mistletoe
Motherwort
Parsley, Apiole
Pleurisy Root
Prickly Ash
Quassia
Shepherd's Purse
Squill, Cardiac glycosides
Wild, Carrot
The German Commission E has noted that the absorption of substances administered simultaneously with sarsaparilla is increased e.g. digitalis glycosides and bismuth.
The German Commission E notes the possibility for licorice to increase potassium losses from other drugs e.g. diuretics which can then increase the sensitivity to digitalis glycosides.
The German Commission E also notes the possibility for chronic use of rhubarb, via depletion of potassium resources, to potentiate cardiac glycosides and interact with antiarrhythmia drugs.
The German Commission E notes the possibility of hypokalemia [from chronic senna usage (abuse?)] to potentiate the action of cardiac glycosides and antiarrhythmic agents.
References
Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.
Botzler R, Ritter U. Effect of laxative measures on the serum concentration of digoxin in the human. Leber Magen Darm Nov 1982 ;12(6):255-57 [in German].
Brinker, F. Herb Contraindications and Drug Interactions. Eclectic Institute, 1998.
Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 1999.
Geriatric Nutrition, 3rd edition (Englewood Cliffs, NJ, Prentice-Hall Inc., 1992)
Gever, Larry, N., June T. Norris, et. al. 1981. Professional Guide to Drugs. Intermed Communications, Inc. Pennsylvania. 1141 pp.
Griffith, H. W. 1983. Complete Guide to Prescription and Non-Prescription. Fisher Publishing, Inc., Tucson.
Holt GA. Food & Drug Interactions. Chicago: Precept Press,1998, 94.
Johnson, BF et al., The effect of dietary fiber on the bioavailability of digoxin in capsules. J. Clin. Pharmacol. 1987, 27:487-490.
Kupfer S, Kosovsky JD: Effects of cardiac glycosides on renal tubular transport of calcium, magnesium, inorganic phosphate and glucose in the dog, J of Clin Investig, 1965, 44:1143
Landauer RA. Magnesium deficiency and digitalis toxicity. JAMA 1984;251:730 [letter/review].
Lieberman, S. & Bruning, N.: The Real Vitamin & Mineral Book. Avery, NY.
Lown, B. : Adv. Intern. Med. 1956, 8: 125.
Martin, David W. Peter A. Muyers, et. al. 1983. Harper's Review of Biochemistry. Lange Medical Publications. Los/Altos, Ca. 638 pp.
May, JR et al: Drug interactions in surgical patients. Am J Surg 1987 Mar;153(3):327-35.
Nala, G.T. et al: Am. Heart J. 1970, 79: 499.
Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-care Professionals. London: The Pharmaceutical Press, 1996.
Osol, Arthur. 1980. Remington's Pharmaceutical Sciences. Mack Publishing Company, Pennsylvania.
Pronsky, Zaneta. Food Medication Interactions. 11th edition. 1999
Schwinger RH, Eromann E: Heart failure and electrolyte disturbances, Methods find Exp Clin Pharmacol, 1992, 14(4): 315-25
Smith, C.H. (Ed): Dietary concerns associated with the use of medications. JADA, 1984, 84(8): 901.
Tyler VE. The Honest Herbal, 3rd ed. New York: Pharmaceutical Products Press, 1993, 198.
Wang DJ, Chu KM, Chen JD, et al. Drug interaction between digoxin and bisacodyl. J Formes Med Assoc 1990;89:913, 915-19 [in Chinese].
Whang R, Oei TO, Watanabe A. Frequency of hypomagnesiumia in hospitalized patients receiving digitalis. Arch Intern Med 1985;145:655-56.
Zangen A, Botzer D, Zangen R, et al: Furosemide and digoxin inhibit thiamine uptake in cardiac cells, Eur J Pharmacol, 1998, 361 (1):151-5.
| Signup Free Applied Health Journal |
||||
|
FREE Sample Issue Your email address is all we need to start you on a better path to health. We respect your privacy.
|
