Stewart and Newman, and DeGraff, Batterman, and Rose have expressed their disapproval of digitoxin for routine use in the treatment of heart disease. They have pointed out the disadvantages of digitoxin but at the same time have shown considerable concern regarding statements about this drug. It is my impression that at least a part of the disrepute which may have overtaken digitoxin is due as much to the criticism which has been directed at Gold's recommendations for use of the drug as to any inherent defect in the drug itself. Variables such as size of the patient, advanced age, degree of cardiac hypertrophy, nature of the underlying disease process, and general debility of the patient must be taken into consideration when digitoxin is used, just as when any other form of digitalis is used. Batterman and DeGraff believed that digoxin is the most nearly ideal digitalis preparation.
Digoxin shows a rapid onset of action and is rapidly excreted.
Schwab and Freedberg and Zoll pointed out that the rapidity of excretion makes maintenance of digitalization difficult, and they regarded the rapid dissipation of the drug within the body as a serious disadvantage. On the other hand, the whole-leaf preparations, digitoxin, or digoxin may each be considered as a satisfactory product for the initiation and maintenance of digitalization. Each has its advantages and disadvantages. If William Withering, with his crude infusions of foxglove, was able to obtain satisfactory results, the modern physician with the excellent preparations of digitalis available to him is indeed in a position to be of outstanding service to the patient with heart disease. Undoubtedly, the first time I heard about cardiac glycosides was in 1982, when I was a second-year medical student in a pharmacology course.