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Digitoxin

Digoxin is a cardiac glycoside extracted from the foxglove plant, digitalis. It is widely used in the treatment of various heart conditions, namely atrial fibrillation, atrial flutter and congestive heart failure that cannot be controlled by other medication. more...

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The main effects of digoxin are on the heart, its extracardiac effects are responsible for most of the side effects, i.e. nausea, vomiting, diarrhea and confusion.

Its main cardiac effects are:

  • A decrease of conduction of electrical impulses through the AV node, making it a commonly used drug in controlling the heart rate during atrial fibrillation or atrial flutter.
  • An increase of force of contraction via inhibition of the Na+/K+ ATPase pump (see below).

Mechanism of action

Digoxin binds to a site on the extracellular aspect of the α-subunit of the Na+/K+ ATPase pump in the membranes of heart cells (myocytes). This causes an increase in the level of sodium ions in the myocytes, which then leads to a rise in the level of calcium ions. The proposed mechanism is the following: inhibition of the Na+/K+ pump leads to increased Na+ levels, which in turn slows down the extrusion of Ca2+ via the Na+/Ca2+ exchange pump. Increased amounts of Ca2+ are then stored in the sarcoplasmic reticulum and released by each action potential, which is unchanged by digoxin. This is a different mechanism from that of catecholamines.

Digoxin also increases vagal activity via its central action on the central nervous system, thus decreasing the conduction of electrical impulses through the AV node. This is important for its clinical use in different arrhythmias (see below).

Clinical use

Today, the most common indications for digoxin are probably atrial fibrillation and atrial flutter with rapid ventricular response. High ventricular rate leads to insufficient diastolic filling time. By slowing down the conduction in the AV node and increasing its refractory period, digoxin can reduce the ventricular rate. The arrhythmia itself is not affected, but the pumping function of the heart improves owing to improved filling.

The use of digoxin in congestive heart failure during sinus rhythm is controversial. In theory the increased force of contraction should lead to improved pumping function of the heart, but its effect on prognosis is disputable and digoxin is no longer the first choice for congestive heart failure. However, it can still be useful in patients who remain symptomatic despite proper diuretic and ACE inhibitor treatment.

Digoxin is usually given by mouth, but can also be given by IV injection in urgent situations (the IV injection should be slow, heart rhythm should be monitored). The half life is about 36 hours, digoxin is given once daily, usually in 125μg or 250μg dosing. In patients with decreased kidney function the half life is considerably longer, calling for a reduction in dosing or a switch to a different glycoside (digitoxin).

Read more at Wikipedia.org


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New encyclopedia for CAM practitioners
From Townsend Letter for Doctors and Patients, 4/1/05 by Robert A. Anderson

The Encyclopedia of Medical Breakthroughs and Forbidden Treatments

Shoreline, Washington. Medical Research Associates, 2005

$24.95, order at www.medical-breakthroughs.com or 1-800-247-6553

This 8.5 X 11 soft-cover-bound volume is presented in four major sections: 1) Background; 2) Information on 60 specific ailments; 3) Topical Pain Relievers; and 4) General Treatment Methods. As a data aficionado, I have found numerous items of great interest in my review.

This volume will serve the practitioner best as a reference volume. The authors give an interesting emphasis on the topic of pain in both the background section and in Part III as well, for good reason. The $50 billion annual price tag in the US for managing pain is a reminder of why that should be so.

Interesting expanded sound bytes on alternative methods abound. In part II, numerous examples of short synopses of alternatives can be found. For instance, mentioned under "Allergies" are:

* the natural substance quercitin;

* MSM (methyl-sulfonyl-methane);

* NAET (Nambudripad's Allergy Elimination Technique);

* conventional drug treatment with one of the non-drowsy antihistamines is mentioned, along with the story of the manufacturer's chicanery in pushing the drug with marginally supported science.

The authors tackle the major diseases as well with longer synopses. For example, under cancer, the text covers:

* the controversy arising from the Scandinavian study suggesting that mammograms do not promote greater survival (Lancet 2000; 355:129);

* data suggesting the utility of infrared thermography in diagnosis;

* AMAs (anti-malignin antibodies) in cancer detection;

* anti-metastatic measures (heparin, warfarin, prostacyclin, the Chinese herb Qian-Hu, the peptide trigramin, the leech protein antistasin, the Chinese herb Mo-her, the protein galectin-3, modified citrus pectin and Raf kinase inhibitory protein);

* tissue-strengthening and blocking of collagen-dissolving enzymes (vitamin C, lysine, proline);

* the Moss Reports regarding alternative treatments (Dr. Ralph Moss is very familiar to TLfDP readers);

* Paw Paw (Asimina triloba);

* Antineoplastins (Burzynski's work);

* cancer pain management options

I am aware of a small number of areas in the cancer field not mentioned: Hugh Riordan's seminal work on high-dose vitamin C as a cytotoxic agent against cancer cells; the Swedish observation that breast cancer patients on digitoxin have a much lower mortality; and European work suggesting that mistletoe manifests anti-tumor effects (Iscador). So, while this work, like any in its field, is not absolutely complete, the descriptor "encyclopedic" is appropriate. The aggregate number of alternative options is just short of overwhelming.

In the briefly treated part III (Topical Pain Relievers), selected topics include:

* DMSO (dimethyl sulfoxide);

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* light (photon therapy, phototherapy and the use of LEDs [light-emitting diodes]);

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* Pain Away (a proprietary topical herbal combination);

* Penetran+Plus (a proprietary topical application of ammonium compounds which apparently recalibrate juxtaposed neuroelectrical circuits);

* topical arnica products

Part IV deals with a number of selected topics not always addressed in comprehensive reviews of alternatives:

* Bowen Therapy (an osteopathic soft tissue therapy re-balancing neuromuscular relationships);

* hyperbaric oxygen therapy (including a brief paragraph regarding use in ischemic stroke);

* insulin potentiation therapy (capitalizing on the increased numbers of insulin receptor sites on malignant and other cells;

* detoxification and deficiencies (including exercise as a "wonder drug");

* olive leaf extract (Olea eurpoaea L.) (anti-microbiological actions and other properties);

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The authors have also chosen to mention a number of examples bearing evidence that the pharmaceutical-medical complex is not averse to selectively manipulating data which argue against the availability of alternative options in medical practice. We may not be as aware as we might be of the many ways in which this influence operates. The recent well-publicized example of the apparent suppression of toxic data regarding rofecoxib may only be the tip of the iceberg.

I have found this volume to be a sparkling additional vital resource in my own library of alternative methods for holistic medical practice, many of which have substantial and surprising documentation. I have already salted away a number of them for my own future use. For the medical practitioner wishing to have available the widest variety of alternative resources, the "Encyclopedia" will be a must.

review by Robert A. Anderson, MD, ABHM, FAAFP, FACPM

COPYRIGHT 2005 The Townsend Letter Group
COPYRIGHT 2005 Gale Group

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