Digitalis

Digitalis (/ˌdɪdʒɪˈteɪlɪs/[1] or /ˌdɪdʒɪˈtælɪs/[2]) is a genus of about 20 species of

Foxglove
herbaceous perennials, shrubs, and biennials commonly called foxgloves.

This genus was traditionally placed in the figwort family Scrophulariaceae, but
recent phylogenetic research has placed it in the much enlarged family
Plantaginaceae.[3] This genus is native to western and southwestern Europe,[4]
western and central Asia and northwestern Africa. The scientific name means
"finger-like" and refers to the ease with which a flower of Digitalis purpurea can
be fitted over a human fingertip. The flowers are produced on a tall spike, are
tubular, and vary in colour with species, from purple to pink, white, and yellow.
The best-known species is the common foxglove, Digitalis purpurea. This
biennial plant is often grown as anornamental plant due to its vivid flowers which
range in colour from various purple tints through various shades of light gray, and
to purely white. The flowers can also possess various marks and spottings.

The first year of growth of the common foxglove produces only the stem with its
long, basal leaves. During the second year of the plant's life, a long, leafy stem
from 50 to 255 centimetres tall grows atop the roots of healthy plants. Digitalis purpurea (Common foxglove)

Larvae of the foxglove pug, a moth, consume the flowers of the common
Scientific classification
foxglove for food. Other species of Lepidoptera eat the leaves, including the Kingdom: Plantae
lesser yellow underwing.
Clade: Angiosperms
The term digitalis is also used for drug preparations that contain cardiac Clade: Eudicots
glycosides, particularly one called digoxin, extracted from various plants of this
Clade: Asterids
genus.
Order: Lamiales
Family: Plantaginaceae
Tribe: Digitalideae
Contents
Genus: Digitalis
Etymology
L.
Habitat
Medicinal uses Species
Cardiac
Variations Over 20 species, including:
Mechanism of action Digitalis canariensis
Digitalis cariensis
Toxicity
Digitalis ciliata
Digoxigenin
Digitalis davisiana
References
Digitalis dubia
External links
Digitalis ferruginea
Digitalis × fulva
Digitalis grandiflora
Etymology Digitalis isabelliana
Digitalis laevigata
Digitalis lanata
The name is recorded in Old English as foxes glofe/glofa 'fox's glove',[5] though Digitalis leucophaea
there it does not refer to Digitalis.[6] Although the elements of the name are Digitalis lutea
transparent, their meaning is not. Because it is not clear why the flower should be Digitalis mariana
called foxglove, other etymologies have been offered. Henry Fox Talbot (1847) Digitalis micrantha
proposed folks' glove, where folk means fairy.[6] Similarly, R. C. A. Prior (1863) Digitalis obscura
suggested an etymology of foxes-glew, meaning 'fairy music'.[6] However, neither Digitalis parviflora
of these suggestions account for the Old English formfoxes glofa.[7] Digitalis purpurea
Digitalis sceptrum
The genus digitalis is from the Latin digitus (finger), so named for the shape of
Digitalis thapsi
the flowers that resemble a finger.[8]
Digitalis trojana
Digitalis viridiflora
Habitat
Digitalis species thrive in acidic soils, in partial sunlight to deep shade, in a range of habitats,
including open woods, woodland clearings, moorland and heath margins, sea-cliffs, rocky
mountain slopes and hedge banks.[4][9] It is commonly found on sites where the ground has
[10]
been disturbed, such as recently cleared woodland, or where the vegetation has been burnt.

Medicinal uses

Cardiac
A group of medicines extracted from foxglove plants are called digitalin. The use of D.
purpurea extract containing cardiac glycosides for the treatment of heart conditions was first
described in the English-speaking medical literature byWilliam Withering, in 1785,[11][12][13]
[14][15] It is used to increase cardiac
which is considered the beginning of modern therapeutics.
Digitalis lutea
contractility (it is a positive inotrope) and as an antiarrhythmic agent to control the heart rate,
particularly in the irregular (and often fast) atrial fibrillation. Digitalis is hence often
prescribed for patients in atrial fibrillation, especially if they have been diagnosed with congestive heart failure. Digoxin was
approved for heart failure in 1998 under current regulations by the Food and Drug Administration on the basis of prospective,
randomized study and clinical trials. It was also approved for the control of ventricular response rate for patients with atrial
fibrillation. American College of Cardiology/American Heart Association guidelines recommend digoxin for symptomatic chronic
heart failure for patients with reduced systolic function, preservation of systolic function, and/or rate control for atrial fibrillation with
a rapid ventricular response. Heart Failure Society of America guidelines for heart failure provide similar recommendations. Despite
its relatively recent approval by the Food and Drug Administration and the guideline recommendations, the therapeutic use of
digoxin is declining in patients with heart failure—likely the result of several factors. Safety concerns regarding a proposed link
between digoxin therapy and increased mortality in women may be contributing to the decline in therapeutic use of digoxin.

Variations
A group of pharmacologically active compounds are extracted mostly from the leaves of the second year's growth, and in pure form
are referred to by common chemical names, such as digitoxin or digoxin, or by brand names such as Crystodigin and Lanoxin,
respectively. The two drugs differ in that digoxin has an additional hydroxyl group at the C-3 position on the B-ring (adjacent to the
pentane). Both molecules include alactone and a triple-repeatingsugar called a glycoside.

Mechanism of action
Digitalis works by inhibiting sodium-potassium ATPase. This results in an increased intracellular concentration of sodium ions and
thus a decreased concentration gradient across the cell membrane. This increase in intracellular sodium causes the Na/Ca exchanger
to reverse potential, i.e., transition from pumping sodium into the cell in exchange for pumping calcium out of the cell, to pumping
sodium out of the cell in exchange for pumping calcium into the cell. This leads to
an increase in cytoplasmic calcium concentration, which improves cardiac
contractility. Under normal physiological conditions, the cytoplasmic calcium used
in cardiac contractions originates from the sarcoplasmic reticulum, an intracellular
organelle that specializes in the storage of calcium. Human newborns, some animals,
and patients with chronic heart failure lack well developed and fully functioning
sarcoplasmic reticula and must rely on the Na/Ca exchanger to provide all or a
majority of the cytoplasmic calcium required for cardiac contraction. For this to
occur, cytoplasmic sodium must exceed its typical concentration to favor a reversal
in potential, which naturally occurs in human newborns and some animals primarily
through an elevated heart rate; in patients with chronic heart failure it occurs through
the administration of digitalis. As a result of increased contractility, stroke volume is
increased. Ultimately, digitalis increases cardiac output (Cardiac Output=Stroke
Volume x Heart Rate). This is the mechanism that makes this drug a popular
treatment for congestive heart failure, which is characterized by low cardiac output.
Digitalis also has a vagal effect on the parasympathetic nervous system, and as such
is used in re-entrant cardiac arrhythmias and to slow the ventricular rate during atrial
fibrillation. The dependence on the vagal effect means digitalis is not effective when
a patient has a high sympathetic nervous systemdrive, which is the case with acutely
ill persons, and also during exercise. A patch of Digitalis purpurea and
Digitalis lutea in Seattle, WA.
Toxicity
Digitalis toxicity (Digitalis intoxication) results from an overdose of digitalis and
causes nausea, vomiting and diarrhea, as well as sometimes resulting in xanthopsia
(jaundiced or yellow vision) and the appearance of blurred outlines (halos), drooling,
abnormal heart rate, cardiac arrhythmias, weakness, collapse, dilated pupils, tremors,
seizures, and even death. Bradycardia also occurs. Because a frequent side effect of
digitalis is reduction of appetite, some individuals have used the drug as a weight-
loss aid.

Digitalis is an example of a drug derived from a plant that was formerly used by
folklorists and herbalists; herbalists have largely abandoned its use because of its
narrow therapeutic index and the difficulty of determining the amount of active drug
in herbal preparations. Once the usefulness of digitalis in regulating the human pulse
was understood, it was employed for a variety of purposes, including the treatment
of epilepsy and other seizure disorders, which are now considered to be
inappropriate treatments. Digitalis purpurea drawings by Franz
Köhler
Depending on the species, the digitalis plant may contain several deadly
physiological and chemically related cardiac and steroidal glycosides. Thus, the
digitalis plants have earned several, more sinister
, names: dead man’s bells and witch's gloves.

The entire plant is toxic (including the roots and seeds). Mortality is rare, but case reports do exist. Most plant exposures occur in
children younger than six years and are usually unintentional and without associated significant toxicity. More serious toxicity occurs
with intentional ingestions by adolescents and adults.[16] Early symptoms of ingestion include nausea, vomiting, diarrhea, abdominal
pain, wild hallucinations, delirium, and severe headache. Depending on the severity of the toxicosis, the victim may later suffer
irregular and slow pulse,tremors, various cerebral disturbances, especially of a visual nature (unusual colour visions (see xanthopsia)
with objects appearing yellowish to green, and blue halos around lights),convulsions, and deadly disturbances of the heart. For a case
description, see the paper by Lacassie.[17] Vincent van Gogh's "Yellow Period" may have been influenced by digitalis therapy which,
at the time, was thought to control seizures. As noted above, other oculotoxic effects of digitalis include generalized blurry vision, as
well as seeing a "halo" around each point of light.[18]

In some instances, people have confused digitalis with the relatively harmless comfreySymphytum)
( plant, which is often brewed into
a tea, with fatal consequences. Other fatal accidents involve children drinking the water in a vase containing digitalis plants.[19]
Drying does not reduce the toxicity of the plant. The plant is toxic to animals, including all classes of livestock and poultry, as well as
felines and canines.

Digitalis poisoning can cause heart block and either bradycardia (decreased heart rate) or tachycardia (increased heart rate),
depending on the dose and the condition of one's heart. Notably, the electric cardioversion (to "shock" the heart) is generally not
indicated in ventricular fibrillation in digitalis toxicity, as it can increase the dysrhythmia. Also, the classic drug of choice for
ventricular fibrillation in emergency setting,[20] amiodarone, can worsen the dysrhythmia caused by digitalis, therefore, the second-
choice drug lidocaine is more commonly used.

Digoxigenin
Digoxigenin (DIG) is a steroid found exclusively in the flowers and leaves of the plants D. purpurea and D. lanata. It is used as a
molecular probe to detect DNA or RNA. It can easily be attached to nucleotides by chemical modifications. DIG molecules are often
linked to uridine nucleotides; DIG-labelled uridine (DIG-U) can then be incorporated into RNA probes via in vitro transcription.
Once hybridisation occurs in situ, RNA probes with the incorporated DIG-U can be detected with anti-DIG antibodies that are
conjugated to alkaline phosphatase. To reveal the hybridised transcripts, alkaline phosphatase can be reacted with a chromogen to
produce a coloured precipitate.

References
1. OED: "Digitalis"
2. Digitalis (http://dictionary.reference.com/browse/digitalis) at Dictionary.com]
3. Olmstead, R. G.; dePamphilis, C. W.; Wolfe, A. D.; Young, N. D.; Elisons, W. J. & Reeves P. A. (2001).
"Disintegration of the Scrophulariaceae"(http://www.amjbot.org/cgi/content/full/88/2/348). American Journal of
Botany. American Journal of Botany, Vol. 88, No. 2. 88 (2): 348–361. doi:10.2307/2657024 (https://doi.org/10.2307%
2F2657024). JSTOR 2657024 (https://www.jstor.org/stable/2657024). PMID 11222255 (https://www.ncbi.nlm.nih.go
v/pubmed/11222255).
4. Anon. "Foxglove (Digitalis purpurea)"(http://www.arkive.org/foxglove/digitalis-purpurea/range-and-habitat.html).
Arkive: images of life on Earth. Wildscreen. Retrieved 6 May 2010.
5. "Dictionary of Old English: s.v. fox" (https://web.archive.org/web/20150812050412/http://tapor .library.utoronto.ca/doe/
dict/indices/headwordsindexf.html). tapor.library.utoronto.ca. Archived from the original (http://tapor.library.utoronto.c
a/doe/dict/indices/headwordsindexf.html)on 12 August 2015. Retrieved 10 August 2015.
6. Liberman, Anatoly (2010-11-10). "Etymologists at War with a Flower: Foxglove| OUPblog" (https://web.archive.org/w
eb/20130508161659/http://blog.oup.com/2010/11/foxglove/) . Archived from the original (http://blog.oup.com/2010/1
1/foxglove/) on 2013-05-08. Retrieved 2015-08-10.
7. Liberman, Anatoly (2010-11-10). "Etymologists at War with a Flower: Foxglove| OUPblog" (https://web.archive.org/w
eb/20130508161659/http://blog.oup.com/2010/11/foxglove/) . Archived from the original (http://blog.oup.com/2010/1
1/foxglove/) on 2013-05-08. Retrieved 2015-08-10.

Liberman writes: "In sum, foxglove means foxglove, and this disturbing fact has to be accepted."
8. Hollman, A (September 1985)."Plants and cardiac glycosides"(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818
93/pdf/brheartj00117-0032.pdf)(PDF). Br Heart J. 54 (3): 258–261. PMC 481893 (https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC481893) . Retrieved July 6, 2017.
9. Anon. "Foxglove: Digitalis purpurea (Scrophulariaceae)"(http://aggie-horticulture.tamu.edu/wildseed/27/27.4.html)
.
Wildflowers in Bloom. Wildseed farms. Retrieved 7 May 2010.
10. Klein, Carol (18 May 2002)."How to grow: Foxgloves"(http://www.telegraph.co.uk/gardening/howtogrow/3300521/H
ow-to-grow-Foxgloves.html). The Telegraph. London, UK: Telegraph Media Group Limited. Retrieved 6 May 2010.
11. William Withering, An Account of the Foxglove and some of its Medical Uses(https://books.google.com/books?id=V
gIta49rzT4C&pg=PR3#v=onepage&q&f=false)(Birmingham, England: M. Swinney, 1785).
12. Goldthorp WO (2009). "Medical Classics: An Account of the Foxglove and Some of its Medicinal Uses by William
Withering, published 1785".Br Med J. 338: b2189.
13. Simpson, Beryl Brintnall; Ogorzaly, Molly Coner (2001). Economic Botany (3rd ed.). Boston: Mc Graw Hill. p. 529.
ISBN 9780072909388.
14. In contemporary medicine, a purer form of digitalis (usuallydigoxin) is obtained from D. lanata.
15. Digoxin comes from Digitalis lanata. Hollman A.BMJ 1996;312:912. online version accessed 18 October 2006[1] (ht
tp://bmj.bmjjournals.com/cgi/content/full/312/7035/912)
16. "Cardiac Glycoside Plant Poisoning: Medscape reference"(http://emedicine.medscape.com/article/816781-overview
#a0199). Retrieved 3 July 2012.
17. A non-fatal case of intoxication with foxglove, documented by means of liquid chromatography-electrospray-mass
spectrometry. Lacassie E et al., J Forensic Sci. 2000 Sep;45(5):1154–8. Abstract accessed online 19 September
2006. [2] (https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstra ctPlus&list_uids=
11005196&query_hl=13&itool=pubmed_DocSum)
18. Goldfrank LW (2006). Goldfrank's Toxicologic Emergencies(8th ed.). New York: McGraw-Hill.
19. Anon. "Notes on poisoning:Digitalis purpura"(https://web.archive.org/web/20111013203513/http://www .cbif.gc.ca/pl
s/pp/ppack.info?p_psn=57&p_type=all&p_sci=sci) . Canadian poisonous plants information system . Canadian
Biodiversity Information Facility. Archived from the original (http://www.cbif.gc.ca/pls/pp/ppack.info?p_psn=57&p_typ
e=all&p_sci=sci) on 13 October 2011. Retrieved 9 March 2013.
20. "European Resuscitation Council"(http://www.erc.edu).

External links
Flora Europaea: Digitalis species list
Molecule of the Month - Digitalis
eMedicine link
"Foxglove". Collier's New Encyclopedia. 1921.

Retrieved from "https://en.wikipedia.org/w/index.php?title=Digitalis&oldid=821597162

"

This page was last edited on 21 January 2018, at 13:09.

Text is available under theCreative Commons Attribution-ShareAlike License ; additional terms may apply. By using this
site, you agree to the Terms of Use and Privacy Policy. Wikipedia® is a registered trademark of theWikimedia
Foundation, Inc., a non-profit organization.