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Foxglove Paper

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Foxglove Digitalis is from the Figwort Family which is also known as Scrophulariaceae. The Foxglove is a perennial plant that has soft, hairy, ovate and lance-shaped leaves in a basal rosette (Munro). The petal colors vary and include white, yellow, pink, rose, lavender, red and purple (www.gardenguides). The flowers have purple or white spots and are thimble-like or bell shaped. The flowers hang downward and are 1.5 to 2.5 inches in length (Grieve). The flowers last approximately six days after blooming and typically bloom from the end of June to the middle of July (Withering). The plant grows between 2 to 6 feet in height and 18 inches in width. Foxglove grows best in partly shaded areas where the soil is rich and slightly acidic (www.gardenguides). It prefers an average amount of moisture and is often found in crevices of granite walls, dry hilly pastures, roadsides and rocky places (www.gardenguides). It has a short life span; living for only 2 years. The first year the growth remains in a basal rosette of leaves. The second year the flowering stems are produced (Munro). Foxglove digitalis is native to Europe and the Pacific Northwest United States but today it is grown commercially and used to produce the heart drugs Digoxin and Digitoxin (Munro). The name Foxglove digitalis has its roots in Latin where the word digitalis means finger. This was used to describe the blossoms of the plant that fit the human finger perfectly. Foxglove digitalis has several other names including the name foxes glofa. This name was given to the plant by the Anglo-Saxons because the flowers of the plant resemble fingers of a glove (Munro). A common folk lore suggests that folk’s glove was another name used for this plant. “Folks” referred to woodland fairies or little people and as the story goes the woodland fairies gave the blossoms to the fox to put on his toes so that he might soften his tread while he hunted for his prey (Munro). Other common names of this plant pertain to its toxic nature. They include; witches glove, dead man’s bells, and bloody fingers (Munro). Ingestion of this plant can be fatal at any time during the life span of the plant but it is most toxic just before the seeds ripen. The whole plant is toxic but the upper leaves of the stem are more toxic than the lower leaves. The plant contains various glycosides that if ingested induce dizziness, vomiting, irregular heartbeats, delirium and hallucinations (Munro). In the past, Foxglove was used by herbalists as an ointment to cleanse wounds and reduce swelling. It was also boiled and used as an expectorant (Munro). William Withering in his book “An Account of the Foxglove and some of its Medical Uses” explains that Foxglove Digitalis can be used to treat numerous diseases including; epilepsy, insanity, nephritis calculosa, hydrothorax and dropsy. William Withering is best known for his discovery of foxglove digitalis to treat dropsy which is known today as congestive heart failure. He discovered that small doses over several hours would lead to increased urine production and an overall well being of the patient (Withering). Today, Foxglove Digitalis is the source for the drugs Digoxin and Digitoxin which are used on congestive heart failure patients to increase the force of systolic contractions and prolong the duration of diastole. It also helps lower venous pressure, elevate blood pressure, act as a diuretic and reduce edema (Munro). A study done by Milton Packer et al. known as the “RADIANCE” study was done to assess the role of digoxin in patients receiving a converting-enzyme inhibitor and to evaluate the effects associated with withdrawal of digoxin from patients with chronic heart failure who were clinically stable and receiving digoxin along with diuretics and a converting-enzyme inhibitor. One hundred and seventy eight chronic heart failure patients from 43 centers throughout the United States and Canada were enrolled in the study. The patients were eligible if they had a left ventricular ejection fraction of 35 percent or less, a left ventricular end-diastolic dimension of 60 mm or more, reduced exercise capacity with duration between 2 to 14 minutes and a normal sinus rhythm. The protocol was approved by the institutional review boards and informed consent was obtained from all the patients who participated in the study. The eligible patients were enrolled in the double-blind experiment and were given digoxin therapy with diuretics and a converting-enzyme inhibitor or a placebo with diuretics and a converting-enzyme inhibitor for a three month period. Throughout the three month period, the patients were examined for symptoms and functional status every two weeks. At weeks 2, 6 and 12 the patients treadmill exercise capacity was measured and at weeks 4, 8, and 10 their exercise endurance was assessed via a six minute walk. After 12 weeks the patient’s quality of life and cardiac function were evaluated. Twenty three patients that received the placebo experienced a worsening in their heart failure that required therapeutic intervention. Only 4 patients that received the digoxin therapy had worsening symptoms. The patients who were part of the placebo group experienced a decrease in treadmill exercise tolerance of 43 seconds over the 12 weeks compared to the digoxin group patients who remained stable. Similarly, the patients receiving digoxin therapy remained stable when tested for exercise endurance, which was defined as the distance walked in a six minute period, but the patients in the placebo group experienced a decrease in endurance of 41 meters. The study discovered that discontinuing digoxin therapy in patients with chronic heart failure, with normal sinus rhythm, experienced a decline in clinical status. The decline was shown by a worsening of functional class and exercise tolerance by the patients. Twenty five percent of the patients who discontinued digoxin therapy had a worsening in heart failure that led to additional treatment including hospitalization or emergency care. The study also showed that patients who continued the digoxin therapy remained stable. The study concluded that discontinuing digoxin carries considerable hazards for heart failure patients even if the patients are clinically stable, have mild symptoms or are receiving optimal medical therapy. Another study performed by Michael Rich et al. known as the DIG study was done to determine if the effect of digoxin on clinical outcomes varies as a function of age and to determine the effect of increasing age on mortality, hospitalizations and digoxin side effects in patients with heart failure. The experiment was a double blind experiment that took place over a 37 month period with individuals grouped into two categories, a digoxin receiving group and a placebo group. There were 7,788 patients that took part in the study and later analysis grouped these individuals into five different age categories which ranged from less than 50 years old, age 50 to 59, age 60 to 69, age 70 to 79 and greater than or equal to 80 years old. The experimenters then studied the correlation between age and mortality, all-cause hospitalizations, heart failure hospitalizations, heart failure death or hospitalization for suspected digoxin toxicity and withdrawal from digoxin therapy as a result of side effects using the Mantel-Haenszel statistic. Kaplan-Meier curves were used to plot age category for total mortality and for the combination of heart failure death and heart failure hospitalizations. The study discovered that increasing age was associated with a progressive increase in the incidence of death, hospitalization, heart failure hospitalizations and heart failure death. It also discovered that digoxin had no effect on the total mortality of patients and it was associated with a reduction in all-cause hospitalizations, heart failure hospitalizations, and heart failure death. The study also determined that digoxin is a useful agent for heart failure treatment that is associated with reduced left ventricular systolic function in patients of all ages. In my research I have found plenty of evidence to support the claim that foxglove digitalis is useful in treating congestive heart failure. Numerous studies have proven that the drug digoxin, which is a derivative of the foxglove plant, is useful in treating patients with reduced left ventricular systolic function. I have not, however, been able to find any evidence that supports foxglove digitalis as a remedy for the treatment of epilepsy, insanity, nephritis calculosa, hydrothorax, an expectorant or for the treatment of wounds. In his book, William Withering expresses caution to all of the physicians that use foxglove digitalis for the treatment of their patients because the therapeutic index for it is very small. That is why I believe that in this day and age the use of foxglove is limited to congestive heart failure and not all of the other disorders that Withering describes. We have plenty of other prescription drugs that can be used to treat these conditions; drugs that are far less toxic and dangerous to the patients they are prescribed to.

Works Cited

2010. www.gardenguides.com/159-foxglove-digitalis-garden-basics-flower-perennial.html.
Grieve, M. 1995. Foxglove. www.botanical.com/botanical/mgmh/f/foxglo30.html.
Munro, D. 2009. Digitalis purpurea (Foxglove). www.ansci.cornell.edu/plants/digitalis/html.
Packer, M. et al. 1993. Withdrawal of Digoxin from Patients with Chronic Heart Failure Treated with Angiotensin-Converting Enzyme Inhibitors. The New England Journal of Medicine, 329:1-7
Rich, M. et al. 2001. Effect of Age on Mortality, Hospitalizations and Response to Digoxin in Patients with Heart Failure: The DIG Study. Journal of the American College of Cardiology, 38:806-813.
Withering, W. An Account of the Foxglove, and Some of its Medical Uses: With Practical Remarks on Dropsy and other Diseases. Swinney, Paternoster Row, London.…...

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