Metabolised by CYP3A4. Clinical observation and two references point to non-porphyrinogenicity.The daily dose is beneath the mg range and hepatocyte exposure beneath the micromolar range.

3β-[(O-2,6-Dideoxy-β-d-ribo-hexopyranosyl-(1→4)-O-2,6-dideoxy-β-d-ribo-hexopyranosyl-(1→4)-2,6-dideoxy-β-d-ribo-hexopyranosyl)oxy]-14β-hydroxy-5β-card-20(22)-enolide. M = 764.9

Glycoside used for digitalisation in heart failure and arrythmia. Steady-state therapeutic plasma concentrations of digitoxin may range from 10 to 35 nanograms/mL.

40% excreted in bile as conjugates after hydrolysis and hydroxylation where CYP3A is involved. Most metabolites are inactive; the major active metabolite is digoxin. Enterohepatic recycling occurs and about 25-30% is excreted unchanged in urine. Digitoxin is very slowly eliminated from the body. The daily dose is beneath the mg range and hepatocyte exposure beneath the micromolar range.

S. Thunell, 2004. Swedish observations (n=11): tolerated.

Tolerance has been described by Kauppinen and Mustajoki (1992).

Uneventful use reported in 1 patient with acute porphyria.