Digitoxin: Renaissance of a Cardiac Glycoside

Digitoxin, a cardiac glycoside derived from the purple foxglove (Digitalis purpurea), is experiencing a remarkable renaissance in modern heart failure therapy thanks to the DIGIT-HF study. The study demonstrates that Digitoxin can significantly reduce the risk of death and hospital admission in patients with systolic heart failure (HFrEF) when added to standard therapy.

Digitoxin as an Addition to the Four Pillars

Heart failure treatment is based on four key drug classes:

1. Beta-blockers

2. RAAS inhibitors or ARNI (Angiotensin Receptor-Neprilysin Inhibitors)

3. Mineralocorticoid Receptor Antagonists (MRA)

4. SGLT2 inhibitors

These medications improve prognosis and quality of life for patients with HFrEF. Yet despite these advances, mortality remains high. This is where Digitoxin comes in—as a fifth pillar that meaningfully complements the existing treatment concept.

Compound Profile: Digitoxin in Detail

Digitoxin is a natural steroid glycoside extracted from the leaves of Digitalis purpurea. It consists of the aglycone digitoxigenin and three sugar residues (digitoxose). The substance acts as a positive inotrope by inhibiting the sodium-potassium ATPase, leading to increased intracellular calcium and stronger heart muscle contractions.

Additionally, Digitoxin has:

• Negative chronotropic effects (slows heart rate)

• Negative dromotropic effects (slows conduction)

• Positive bathmotropic effects (increases excitability of the heart muscle)

A key advantage: Digitoxin is metabolized by the liver, not the kidneys, making it suitable for patients with impaired renal function. Its long half-life (6–8 days) and high bioavailability also make it highly controllable.

Clinical Relevance of the DIGIT-HF Study

The DIGIT-HF study observed over 1,200 patients with advanced heart failure (NYHA III–IV) over three years. The Digitoxin group showed a significant relative risk reduction of 18% in the primary endpoint: death or hospital admission due to worsening heart failure. Patients with low blood pressure and elevated heart rate benefited particularly.

A Compound with History and Future

Digitoxin is more than a traditional compound. It’s a prime example of how plant-based natural substances can regain clinical relevance through modern research.

We supply both the plant-based raw material and the pure compound Digitoxin. Feel free to contact us with any questions.

Sources:

• Ärztezeitung: DIGIT-HF-Studie – Digitoxin von klinischem Nutzen [aerztezeitung.de]

• New England Journal of Medicine: Originalpublikation zur DIGIT-HF-Studie [mhh.de]

• Pharmazeutische Zeitung: Digitoxin besser als sein Ruf [pharmazeut…zeitung.de]