Digitalis: is there a future for this classical ethnopharmacological remedy?

Withering's (1741-1799) greatest merit is not so much that of having discovered the therapeutic value of foxglove in hydropsy, since this indication (among others) was already part of traditional medicine, but actually during a decade of carefully recording clinical observations, he authoritatively settled definite guidelines for its use. In spite of its further utilization in many additional illnesses such as madness, foxglove, and later its main heteroside digitoxine, progressively reached their eventual place in the treatment of supraventricular arrhythmias and in congestive heart failure. In the latter indication, however, its value is now being questioned; it is being accused of augmenting myocardial work due to its vasoconstrictor properties, of favoring dysrhythmic events in a disease already burdened with a 50% arrhythmia mortality, and actually of having a low therapeutic index. Even though being discarded by a number of cardiologists, digitoxine still remains in the appraisal of others as an indispensable medicine.