Herb Drug Mix: Heart Safety

Herbs and drugs for your heart and sorting out what's safe

| November/December 1999

Some herbalists have combined digoxin and hawthorn for years 

Here’s an ironic twist: an herb is made into a popular pharmaceutical drug, and later patients are warned about taking it with other herbs.

I’m talking about foxglove (Digitalis purpurea), the source of the active ingredient in the heart medicine digoxin. Since its popularization by William Withering in 1785, foxglove and its derivatives have been used to successfully treat congestive heart failure (CHF) and arterial fibrillation.

Cardiac glycosides defined 

Foxglove contains cardiac glycosides, molecules that are a combination of sugar and other organic substances. A potent medicine, glycosides block an enzyme that regulates electrical activity in the membranes of heart tissue. Small doses create ­positive effects by enabling the heart to ­contract more slowly and efficiently. But cardiac glycosides are also biological toxins and excessive doses can cause serious problems. By interfering with normal electrical rhythms, they can make the heart beat too slowly or generate extra heartbeats.

Consequently, patients taking digoxin require close monitoring. Many other medications routinely prescribed for heart problems can amplify the toxicity of cardiac ­glycosides, so dosages must be carefully adjusted when used in combination with digoxin. Cardiac glycosides can also cause negative side effects when sodium, potassium, calcium, and magnesium levels are too low, so they must be monitored as well. This means that conditions causing loss of fluids and salts—such as dehydration from diarrhea or use of diuretics-—can induce side effects from digoxin.

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