RARE DISEASE
Digitalis poisoning
Digitalis poisoning
Digitalis poisoning
Drug discovery
1
drug
With orphan designation
Overview
Digitalis poisoning results from excessive intake of cardiac glycosides (e.g., digoxin), leading to life-threatening conduction disturbances. Causes include overdose, renal impairment, drug interactions (e.g., diuretics, amiodarone), or electrolyte imbalances (hypokalemia, hypomagnesemia). Symptoms span gastrointestinal (nausea, vomiting), neurological (confusion), visual (color perception changes), and cardiovascular effects (arrhythmias, hyperkalemia). Diagnosis relies on serum digoxin levels, ECG findings, and clinical history. Treatment prioritizes digoxin-specific antibodies (Fab fragments) for severe toxicity, alongside supportive care (electrolyte correction, decontamination).
Categories: rare disorders due to toxic effects
Research Papers
351 drug discovery papers about Digitalis poisoning, with 1 first-in-class and 2 next-in-class emerging drug candidates forecasted to outperform the average preclinical success rate. Recent publications:
351 drug discovery papers about Digitalis poisoning, with 1 first-in-class and 2 next-in-class emerging drug candidates forecasted to outperform the average preclinical success rate. Recent publications:
2026-03-27 | Fatal Yellow Oleander Poisoning From a Weight-Loss Seed Product Requiring Venoarterial Extracorporeal Membrane Oxygenation.
Yellow oleander (Cascabela thevetia) seeds marketed as "slimming seeds" in unregulated weight-loss products can cause life-threatening digitalis-like toxicity. A 47-year-old woman accidentally ingested approximately 50 yellow oleander seeds sold as a weight-loss supplement. She developed gastrointestinal symptoms, atrial tachyarrhythmias with high-grade atrioventricular block, hyperkalemia, and metabolic acidosis. She received activated charcoal and digoxin immune Fab with transient improvement. Twelve hours later, evolving acute kidney injury led to recurrent refractory ventricular fibrillation. Despite extracorporeal cardiopulmonary resuscitation and venoarterial extracorporeal membrane oxygenation, she died. This case highlights delayed recurrence after a large plant cardiac glycoside ingestion, limitations of total serum digoxin assays after Fab administration, and the risk of catecholaminergic agents precipitating ventricular arrhythmias. Early digoxin immune Fab guided by electrocardiography and potassium levels-rather than total digoxin levels-is critical. Delayed recurrence should be anticipated with large ingestions and renal impairment.
2025-03-19 | A successful termination of bidirectional ventricular tachycardia followed by intravenous lidocaine.
TITLE OF CASE A successful termination of bidirectional ventricular tachycardia followed by intravenous lidocaine. KEY CLINICAL MESSAGE Bidirectional ventricular tachycardia, once a hallmark of severe digitalis toxicity, can also result from causes like catecholaminergic polymorphic VT, aconite poisoning, genetic channelopathies, myocarditis, and myocardial infarction. While electrical cardioversion is recommended for unstable VT, tailored treatments, including intravenous lidocaine, may be effective for BVT-associated myocardial infarction. INTRODUCTION Bidirectional ventricular tachycardia (BVT) is a rare and life-threatening arrhythmia with a limited differential diagnosis, including digitalis toxicity, catecholaminergic ventricular tachycardia, aconite poisoning, hereditary channelopathy syndromes, myocarditis and myocardial infarction[1 2]. The precise cause of BVT remains poorly understood. Current guidelines for ventricular tachycardia management typically recommend beta-blockers, propafenone, or flecainide[3]. However, intravenous lidocaine has not been previously recognized as a treatment for BVT. We report a case of a patient presenting to the emergency department with chest pain and hypotension, diagnosed with unstable BVT, which was successfully treated with intravenous lidocaine, restoring normal sinus rhythm. The patient was stabilized, transferred to the cardiac care unit, and later diagnosed with myocardial infarction after cardiac catheterization. The pathophysiology of BDVT is similar to other forms of ventricular tachycardia, involving delayed afterdepolarization, reentry, and automaticity. Given that lidocaine is effective for ventricular tachycardia associated with MI, it may also be beneficial in BVT cases associated with myocardial infarction. KEYWORDS Ventricular, Tachycardia, Myocardial Infarction, Lidocaine, Acute Coronary Syndrome. CASE HISTORY/EXAMINATION An Asian male who was in his 40s with a significant medical history of morbid obesity (BMI of 31), ischemic cardiomyopathy, and a decreased left ventricular ejection fraction (19%) without a prior history of cardiac arrhythmias visited the ED with 30 minutes of central chest discomfort radiating to the left arm. The patient was alert with a blood pressure of 90/69 mmHg, a heart rate of 167 beats per minute, a respiratory rate of 22 breaths per minute, and a capillary refill time of less than 2 seconds. No signs of heart failure were observed. A 12-lead electrocardiogram (ECG) showed significant tachycardia with a rate of 164 beats per minute and bidirectional QRS morphology strongly suggestive of BVT as shown in Figure 1. Following the initial evaluation, the patient remained hypotensive, requiring continuous cardiac monitoring and immediate cardiology consultation with the differential diagnosis of ischemic cardiomyopathy-related VT, acute myocardial infarction, and toxin-related BVT. The patient was subsequently treated with 100 mg of intravenous lidocaine over three minutes instead of synchronized electrical cardioversion since it could worsen his ventricular ejection fraction. Five minutes after lidocaine had been administered, the ECG returned to sinus rhythm as shown in Figure 2 with a blood pressure of 120/58 mmHg. Laboratory studies revealed a troponin-T level of 520 ng/L, while the test results were unremarkable. Digoxin level was not determined due to the absence of a history of drugs or toxin-related ingestion. INVESTIGATIONS Laboratory studies revealed a troponin-T level of 520 ng/L, while the test results were unremarkable. Digoxin level was not determined due to the absence of a history of drugs or toxin-related ingestion. DIFFERENTIAL DIAGNOSIS
2024-12-01 | Use of intravenous calcium in emergencies to treat patients with hyperkalemia and digoxin poisoning and its impact on short-term outcome.
Patients with digitalis intoxication (DI) and hyperkalaemia are frequently encountered in the emergency department (ED). This alteration may require intravenous (iv) calcium, but its administration has been considered to increase cardiotoxicity and mortality in patients with DI. We studied the effect of iv calcium on mortality and 30-day readmission in patients with hyperkalaemia and DI. A retrospective, multicentre, retrospective cohort study including all patients with DI and hyperkalaemia from 2004 to 2023 seen in 6 hospital emergency departments. Two cohorts were created according to iv calcium administration, and demographic, clinical, electrocardiographic and outcome variables (mortality, readmission and combined event at 30 days) were collected. 117 patients with ID and hyperkalaemia were collected and 29% were administered iv calcium. Seventy-eight point 6percent were women, with a median age of 82.8 years. Cardiological symptoms were present in 57.3%, 47% digestive and 37.6% neurological. Cardiac arrhythmia was present in 86.3%, the most frequent type being slow supraventricular arrhythmia in 76.1%. The presence of cardiological symptoms (76.5% vs. 49.4, P=.007), arrhythmias (97.1% vs. 81.9%, P=.037), and higher levels of creatinine (70.6% vs. 42.2%, P=.005) and serum potassium (94.1% vs. 31.3%, P<.001) was more frequent in the group receiving iv calcium. An association was found between the administration of iv calcium An association was found between calcium administration and the combined event at 30 days (ORa 3.11, 95% CI:1.02-9.53), but this increase was at the expense of more readmissions (ORa 3.58, 95% CI, 1.04-12,33), with no relationship found with mortality at 30 days (ORa 0,75, 95% CI: 0.18-3.09). Calcium administration in hyperkalaemia and ID is not associated with short-term mortality.
2023-12-27 | Effect of Uzarin Isolated from Calotropis procera on Blood Electrolytes and Cardiac Related Enzymes
Abstract: Background: Cardiac glycosides are known to be one of the most important drugs that extracted from medicinal plants. Cardiac glycosides have been used as a medicine for a long time with congestive heart failure. Objectives: In this study, we aim to investigate the biochemical changes happened in male rats by Uzarin, the cardiac glycoside isolated from Calotropis procera, to monitor the biochemical changes caused by cardiac glycosides in the long-term therapy or the overdose intake as well. Materials and Methods: Uzarin is isolated and purified from Calotropis procera by chromatographic methods. Uzarin structure was determined by 2 D NMR techniques. Determination of Serum Electrolytes Concentrations and cardiac related enzymes were done using biochemical methods. Results: This study may reflect the changes in serum electrolytes and cardiac related enzymes that happen with cardiac glycosides-dependent patients. Conclusion: Uzarin could significantly decrease K, Na, Ca, Mg and Cl levels 24 hr after injection. In serum, Creatine Kinase (CK) and Lactate Dehydrogenase (LDH) as well as γ-Glutamyl Transferase (GGT) activities were highly increased. Keywords: Uzarin, Cardiac glycosides, Calotropis procera, Serum electrolytes, Cardiac related enzymes.
2023-12-13 | Calotropin: Natural Phytomolecules for Cutting-edge Features
Pharmacognosy Research,2023,16,1,19-25.DOI:10.5530/pres.16.1.3Published:December 2023Type:Review ArticleAuthors:Sourav Nag, Reshmi Paul, Sumanta Mondal, Naresh Panigrahi, and Partha Roy Author(s) affiliations:Sourav Nag, Reshmi Paul, Sumanta Mondal*, Naresh Panigrahi, Partha Roy Department of Pharmaceutical Chemistry, School of Pharmacy, GITAM (Deemed to be University), Visakhapatnam, Andhra Pradesh, INDIA. Abstract:Phytochemical is a collective term for plant chemicals with varied structure and function. The most common sources of phytochemicals are fruits, vegetables, whole grains, nuts and seeds, and other plant foods. Calotropin is a pharmacologically active compound isolated from milkweed plants like Calotropis procera, Calotropis gigantea, and Asclepias curassavica that belong to the Asclepiadaceae family which is used for medicinal purposes in many Asian countries. Calotropin is identified as a highly potent cardenolide that has a similar chemical structure to cardiac glycosides (such as digoxin and digitoxin). Among cardenolides, calotropin is identified as the most promising agent. Calotropin has cytotoxic and anti-tumor impacts, with cancers of the breast, colon, lung, and leukemia malignancies exhibiting the most significant effects. The effects of calotropin on cancer have been extensively studied in preclinical pharmacological studies in vitro using cancer cell lines and in vivo in experimental animal models that have targeted antitumor mechanisms and anticancer signaling pathways. During ancient times, calotropin was utilized in various techniques. A macerated bark extract is frequently utilized for de-hearing hides and tanning. Calotropin is a particularly effective abortifacient or interceptive agent in females. Cardenolide calotropin is poisonous. This critique focused on its chemistry and therapeutic activity in various cancer cells. Keywords:Asclepias curassavica, Calotropin, Calotropis gigantea, Calotropis procera, Cardenolide.View:PDF (595.4 KB)
2026-03-27 | Fatal Yellow Oleander Poisoning From a Weight-Loss Seed Product Requiring Venoarterial Extracorporeal Membrane Oxygenation.
Yellow oleander (Cascabela thevetia) seeds marketed as "slimming seeds" in unregulated weight-loss products can cause life-threatening digitalis-like toxicity. A 47-year-old woman accidentally ingested approximately 50 yellow oleander seeds sold as a weight-loss supplement. She developed gastrointestinal symptoms, atrial tachyarrhythmias with high-grade atrioventricular block, hyperkalemia, and metabolic acidosis. She received activated charcoal and digoxin immune Fab with transient improvement. Twelve hours later, evolving acute kidney injury led to recurrent refractory ventricular fibrillation. Despite extracorporeal cardiopulmonary resuscitation and venoarterial extracorporeal membrane oxygenation, she died. This case highlights delayed recurrence after a large plant cardiac glycoside ingestion, limitations of total serum digoxin assays after Fab administration, and the risk of catecholaminergic agents precipitating ventricular arrhythmias. Early digoxin immune Fab guided by electrocardiography and potassium levels-rather than total digoxin levels-is critical. Delayed recurrence should be anticipated with large ingestions and renal impairment.
2025-03-19 | A successful termination of bidirectional ventricular tachycardia followed by intravenous lidocaine.
TITLE OF CASE A successful termination of bidirectional ventricular tachycardia followed by intravenous lidocaine. KEY CLINICAL MESSAGE Bidirectional ventricular tachycardia, once a hallmark of severe digitalis toxicity, can also result from causes like catecholaminergic polymorphic VT, aconite poisoning, genetic channelopathies, myocarditis, and myocardial infarction. While electrical cardioversion is recommended for unstable VT, tailored treatments, including intravenous lidocaine, may be effective for BVT-associated myocardial infarction. INTRODUCTION Bidirectional ventricular tachycardia (BVT) is a rare and life-threatening arrhythmia with a limited differential diagnosis, including digitalis toxicity, catecholaminergic ventricular tachycardia, aconite poisoning, hereditary channelopathy syndromes, myocarditis and myocardial infarction[1 2]. The precise cause of BVT remains poorly understood. Current guidelines for ventricular tachycardia management typically recommend beta-blockers, propafenone, or flecainide[3]. However, intravenous lidocaine has not been previously recognized as a treatment for BVT. We report a case of a patient presenting to the emergency department with chest pain and hypotension, diagnosed with unstable BVT, which was successfully treated with intravenous lidocaine, restoring normal sinus rhythm. The patient was stabilized, transferred to the cardiac care unit, and later diagnosed with myocardial infarction after cardiac catheterization. The pathophysiology of BDVT is similar to other forms of ventricular tachycardia, involving delayed afterdepolarization, reentry, and automaticity. Given that lidocaine is effective for ventricular tachycardia associated with MI, it may also be beneficial in BVT cases associated with myocardial infarction. KEYWORDS Ventricular, Tachycardia, Myocardial Infarction, Lidocaine, Acute Coronary Syndrome. CASE HISTORY/EXAMINATION An Asian male who was in his 40s with a significant medical history of morbid obesity (BMI of 31), ischemic cardiomyopathy, and a decreased left ventricular ejection fraction (19%) without a prior history of cardiac arrhythmias visited the ED with 30 minutes of central chest discomfort radiating to the left arm. The patient was alert with a blood pressure of 90/69 mmHg, a heart rate of 167 beats per minute, a respiratory rate of 22 breaths per minute, and a capillary refill time of less than 2 seconds. No signs of heart failure were observed. A 12-lead electrocardiogram (ECG) showed significant tachycardia with a rate of 164 beats per minute and bidirectional QRS morphology strongly suggestive of BVT as shown in Figure 1. Following the initial evaluation, the patient remained hypotensive, requiring continuous cardiac monitoring and immediate cardiology consultation with the differential diagnosis of ischemic cardiomyopathy-related VT, acute myocardial infarction, and toxin-related BVT. The patient was subsequently treated with 100 mg of intravenous lidocaine over three minutes instead of synchronized electrical cardioversion since it could worsen his ventricular ejection fraction. Five minutes after lidocaine had been administered, the ECG returned to sinus rhythm as shown in Figure 2 with a blood pressure of 120/58 mmHg. Laboratory studies revealed a troponin-T level of 520 ng/L, while the test results were unremarkable. Digoxin level was not determined due to the absence of a history of drugs or toxin-related ingestion. INVESTIGATIONS Laboratory studies revealed a troponin-T level of 520 ng/L, while the test results were unremarkable. Digoxin level was not determined due to the absence of a history of drugs or toxin-related ingestion. DIFFERENTIAL DIAGNOSIS
2024-12-01 | Use of intravenous calcium in emergencies to treat patients with hyperkalemia and digoxin poisoning and its impact on short-term outcome.
Patients with digitalis intoxication (DI) and hyperkalaemia are frequently encountered in the emergency department (ED). This alteration may require intravenous (iv) calcium, but its administration has been considered to increase cardiotoxicity and mortality in patients with DI. We studied the effect of iv calcium on mortality and 30-day readmission in patients with hyperkalaemia and DI. A retrospective, multicentre, retrospective cohort study including all patients with DI and hyperkalaemia from 2004 to 2023 seen in 6 hospital emergency departments. Two cohorts were created according to iv calcium administration, and demographic, clinical, electrocardiographic and outcome variables (mortality, readmission and combined event at 30 days) were collected. 117 patients with ID and hyperkalaemia were collected and 29% were administered iv calcium. Seventy-eight point 6percent were women, with a median age of 82.8 years. Cardiological symptoms were present in 57.3%, 47% digestive and 37.6% neurological. Cardiac arrhythmia was present in 86.3%, the most frequent type being slow supraventricular arrhythmia in 76.1%. The presence of cardiological symptoms (76.5% vs. 49.4, P=.007), arrhythmias (97.1% vs. 81.9%, P=.037), and higher levels of creatinine (70.6% vs. 42.2%, P=.005) and serum potassium (94.1% vs. 31.3%, P<.001) was more frequent in the group receiving iv calcium. An association was found between the administration of iv calcium An association was found between calcium administration and the combined event at 30 days (ORa 3.11, 95% CI:1.02-9.53), but this increase was at the expense of more readmissions (ORa 3.58, 95% CI, 1.04-12,33), with no relationship found with mortality at 30 days (ORa 0,75, 95% CI: 0.18-3.09). Calcium administration in hyperkalaemia and ID is not associated with short-term mortality.
2023-12-27 | Effect of Uzarin Isolated from Calotropis procera on Blood Electrolytes and Cardiac Related Enzymes
Abstract: Background: Cardiac glycosides are known to be one of the most important drugs that extracted from medicinal plants. Cardiac glycosides have been used as a medicine for a long time with congestive heart failure. Objectives: In this study, we aim to investigate the biochemical changes happened in male rats by Uzarin, the cardiac glycoside isolated from Calotropis procera, to monitor the biochemical changes caused by cardiac glycosides in the long-term therapy or the overdose intake as well. Materials and Methods: Uzarin is isolated and purified from Calotropis procera by chromatographic methods. Uzarin structure was determined by 2 D NMR techniques. Determination of Serum Electrolytes Concentrations and cardiac related enzymes were done using biochemical methods. Results: This study may reflect the changes in serum electrolytes and cardiac related enzymes that happen with cardiac glycosides-dependent patients. Conclusion: Uzarin could significantly decrease K, Na, Ca, Mg and Cl levels 24 hr after injection. In serum, Creatine Kinase (CK) and Lactate Dehydrogenase (LDH) as well as γ-Glutamyl Transferase (GGT) activities were highly increased. Keywords: Uzarin, Cardiac glycosides, Calotropis procera, Serum electrolytes, Cardiac related enzymes.
2023-12-13 | Calotropin: Natural Phytomolecules for Cutting-edge Features
Pharmacognosy Research,2023,16,1,19-25.DOI:10.5530/pres.16.1.3Published:December 2023Type:Review ArticleAuthors:Sourav Nag, Reshmi Paul, Sumanta Mondal, Naresh Panigrahi, and Partha Roy Author(s) affiliations:Sourav Nag, Reshmi Paul, Sumanta Mondal*, Naresh Panigrahi, Partha Roy Department of Pharmaceutical Chemistry, School of Pharmacy, GITAM (Deemed to be University), Visakhapatnam, Andhra Pradesh, INDIA. Abstract:Phytochemical is a collective term for plant chemicals with varied structure and function. The most common sources of phytochemicals are fruits, vegetables, whole grains, nuts and seeds, and other plant foods. Calotropin is a pharmacologically active compound isolated from milkweed plants like Calotropis procera, Calotropis gigantea, and Asclepias curassavica that belong to the Asclepiadaceae family which is used for medicinal purposes in many Asian countries. Calotropin is identified as a highly potent cardenolide that has a similar chemical structure to cardiac glycosides (such as digoxin and digitoxin). Among cardenolides, calotropin is identified as the most promising agent. Calotropin has cytotoxic and anti-tumor impacts, with cancers of the breast, colon, lung, and leukemia malignancies exhibiting the most significant effects. The effects of calotropin on cancer have been extensively studied in preclinical pharmacological studies in vitro using cancer cell lines and in vivo in experimental animal models that have targeted antitumor mechanisms and anticancer signaling pathways. During ancient times, calotropin was utilized in various techniques. A macerated bark extract is frequently utilized for de-hearing hides and tanning. Calotropin is a particularly effective abortifacient or interceptive agent in females. Cardenolide calotropin is poisonous. This critique focused on its chemistry and therapeutic activity in various cancer cells. Keywords:Asclepias curassavica, Calotropin, Calotropis gigantea, Calotropis procera, Cardenolide.View:PDF (595.4 KB)
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Drug Discovery Landscape
1 orphan drug designation for Digitalis poisoning, including 1 approved therapy.
1 orphan drug designation for Digitalis poisoning, including 1 approved therapy.
Drug | Therapy type | Regulator | Orphan designation | Approval | Sponsor |
|---|---|---|---|---|---|
Digoxin immune FAB (Ovine) [Digibind] | antibodies | FDA | 1984-11-01 | 1986-04-22 | Glaxo Wellcome Inc. |
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