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.