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Many medications are discovered from plants (quinine – cinchona trees) or organisms (penicillin – mold [penicillicum]).
Digoxin was isolated from foxglove (Digitalis lanata), a colorful floral plant often found in many gardens. There are other sources of cardioactive steroids (aka cardiac glycosides) that have similar effect as digoxin.
- Oleander (Nerium oleander)
- Yellow orleaner (Thevetia peruviana) – frequently used for suicide in Southeast Asia
- Lily of the valley (Convallari majalis) – use in wedding bouquet
- Dogbane (Apocynum cannabinum)
- Red squill (Urginea maritima)
- Bufo toad (Bufo species)
Non-digoxin cardioactive steroid exposure can result in a positive digoxin level due to cross reactivity. This confirms exposure; however, the “digoxin level” does not represent the true extent of the ingested dose or toxicity.
Non-digoxin cardioactive steroid toxicity
- Digibind also binds to non-digoxin cardioactive steroids.
- However, larger doses are often required (initial dose: 10 to 20 vials) than doses required for digoxin toxicity.