Substances & Homeopatic Remedies

Strophantus hispidus

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---Medicinal Action and Uses---The sole official use of Strophanthus in medicine is for its influence on the circulation, especially in cases of chronic heart weakness. As its action is the same as that of digitalis, although more likely to cause digestive disturbances (Many practitioners are of opinion that Strophanthus does not cause digestive disturbances. - EDITOR), it is often useful as an alternative or adjuvant to the drug. Believed to have greater diuretic power, it is esteemed of greater value in cases complicated with dropsies.

In urgent cases, the effects upon the circulation can be obtained almost immediately by means of the intravenous injection of its active principle. The hypodermic injection of Strophanthin is not recommended, owing to the intense local irritation it causes, and because of its strength it should be used with great care and under medical direction.

---Dosages---Of Extractum Strophanthi of the B.P., from 1/4 to 1 grain. This extract takes the place of a solid preparation and can be administered in pills and capsules, 1 grain being equal to 5 minims of the United States tincture.

Of tincture of Strophanthus, B.P. and U.S.P., 5 to 15 drops.

Of Strophanthin, 1/200 of a grain.
 

The maximum daily dose should not exceed: For g-strophanthin, intravenously, 1/64 grain; by mouth, 1/2 grain. For k-strophanthin, intravenously, 1/40 grain; by mouth, 1/20 grain.

---Poisonous, if any, with Antidotes---The greatest caution should always attend the use of strophanthin, though, unlike digitalis, its effects are not cumulative.2)
    James Herrick (JAMA,59: 2015, 1912) - Proclaimed the M.I. as consequence of coronary thrombosis and cardiotonics (digitalis, strophantus, etc.) as the best therapy. He declared: "The timely use of this remedy may occasionally save live".
4)     Ernst Edens (Munchener Medizinischen Wochenschrift; 37, 1934) - After 3 years using strophantus by intravenous way in angina pectoris and M.I. in more than 100 patients he declared: " Subsequently to the recognition of the strophantus as the best and safest medicine for the myocardial infarction we don't have the right to use it in a patient only for scientific reasons and tests, giving preference to other remedies loosing precious time for the cure". He also expressed his confirmation telling that will come the moment in which the omission of the use of strophantus will be seen as a professional mistake.


Action, Medical Uses, and Dosage.—Externally applied, strophanthus preparations appear to exert no special effects unless applied with hydrous wool fat, when the effects of the drug are said to be apparent. The seeds, however, applied to the cornea produce prolonged anaesthesia (Steinbach). Three or 4 drops of a solution of strophanthin (1 in 1000) applied to the cornea also produce total anaesthesia, including sensibility to heat and cold (difference from cocaine), these sensations being the last to yield and the first to revive after its application. A disagreeable irritation of the conjunctiva has been produced by this use of strophanthin; it has no effect on intraocular pressure or upon vision-accommodation. Strophanthus is a muscle poison. When taken internally its action is primarily upon the voluntary muscles, increasing their contractility, and if the dose be poisonous it causes tetanic paralysis, the muscles being unable to regain their former normal flexibility. Under its toxic influence the muscles first become enfeebled, then somewhat rigid, fibrillary twitchings, which are spontaneous, non-rhythmical and increasing contractions, somewhat similar to those of chorea, are observed, and finally the muscles become pallid, non-contractile and hard. It is these effects that render strophanthus an efficient arrow-poison, the muscular paralysis produced rendering the animal an easy prey to its pursuer. When the muscles are in extreme paralysis lactic acid has been observed to replace the normal alkaline condition. Strophanthus muscular paralysis consists chiefly in diminishing the ability of the muscles to relax, and then in destroying this capability, producing a condition difficult to distinguish from rigor mortis.


Action, Medical Uses, and Dosage.—Externally applied, strophanthus preparations appear to exert no special effects unless applied with hydrous wool fat, when the effects of the drug are said to be apparent. The seeds, however, applied to the cornea produce prolonged anaesthesia (Steinbach). Three or 4 drops of a solution of strophanthin (1 in 1000) applied to the cornea also produce total anaesthesia, including sensibility to heat and cold (difference from cocaine), these sensations being the last to yield and the first to revive after its application. A disagreeable irritation of the conjunctiva has been produced by this use of strophanthin; it has no effect on intraocular pressure or upon vision-accommodation. Strophanthus is a muscle poison. When taken internally its action is primarily upon the voluntary muscles, increasing their contractility, and if the dose be poisonous it causes tetanic paralysis, the muscles being unable to regain their former normal flexibility. Under its toxic influence the muscles first become enfeebled, then somewhat rigid, fibrillary twitchings, which are spontaneous, non-rhythmical and increasing contractions, somewhat similar to those of chorea, are observed, and finally the muscles become pallid, non-contractile and hard. It is these effects that render strophanthus an efficient arrow-poison, the muscular paralysis produced rendering the animal an easy prey to its pursuer. When the muscles are in extreme paralysis lactic acid has been observed to replace the normal alkaline condition. Strophanthus muscular paralysis consists chiefly in diminishing the ability of the muscles to relax, and then in destroying this capability, producing a condition difficult to distinguish from rigor mortis.

Strophanthus does not appear to affect either the spinal cord or to act upon its nerve trunks. Its specific action upon the heart is due to direct contact (through the blood) with the muscular fibres of that organ and not to any effect upon the cardiac nerves. A large dose so increases contractility that a more perfect, energetic, and prolonged systole is the result, and the capability of the muscle to relax is lost, or so diminished that diastole can not take place; after death the ventricle is so completely contracted as to almost efface the cavity, the heart passing from life directly into rigor mortis. According to some it may cease either in systole or diastole. The caliber of the blood vessels is but little influenced by strophanthus; it is strongly diuretic in so far as lack of secretion depends upon low blood pressure, i. e., it increases diuresis in so far as increased blood pressure produces an increased urinary product. It is also thought by some to act specially upon the renal secreting structures. When one is in good physiological condition it is said to have little or no diuretic action; but in diseased conditions, with low blood pressure, it is asserted to excel digitalis in diuretic power.

If strophanthus be given in large doses it produces gastro-intestinal irritation with vomiting and diarrhoea. Small doses, however, act as a bitter tonic, improve the appetite, augment gastric action, and promote digestion. In proper doses it strengthens the heart-muscle, slows cardiac action, increases the interval between beats, reduces the pulse-rate, and powerfully increases arterial tension, not by any effect (to any extent at least) upon the vessels, but by strengthening the heart-muscle, giving increased power. Whether or not the drug is cumulative is still an unsettled question, though it probably is not cumulative unless given too freely in over-lapping doses. The action of strophanthus upon the heart is probably greater than that of any other drug, and its active principle is of far greater potency than the digitalis derivatives.

Strophanthus is a remedy for weak heart from debility of the cardiac muscle, with lack of proper contractile power, as shown by a rapid, weak pulse, and very low blood pressure. The disordered action of the heart is due to lack of tonicity and not from weak walls due to depositions of fat, in which case the drug must be used with extreme circumspection, though in small doses it has been recommended by some as a remedy for cardiac fatty degeneration, as it has also in atheroma of the arteries in the aged. It is a remedy for praecordial pain and for cardiac dyspnoea. It has been strongly endorsed in heart affections with disorders of compensation. Strophanthus is a remedy for valvular heart disease only so far as there is muscular insufficiency, where the compensatory increase of muscular action is not sufficient to offset the valvular insufficiency. "It has been reported useful in cases of mitral regurgitation with dilatation; mitral stenosis with regurgitation; regurgitation with oedema, anasarca, dyspnoea, etc.; mitral insufficiency with palpitation, praecordial pain, cyanosis, dyspnoea, etc." (Annual of Eclectic Med. and Surg., Vol. I, 1890, p. 25). Dr. S. Schiller (ibid., p. 40), a keen observer, says: "When the balance in the circulation has become impaired, as a result of insufficiency of the valves of the heart from organic disease with a general dropsical condition, strophanthus, although affording temporary relief in some cases, has failed in every case in my hands to reestablish the compensation. The result was the same whether the mitral, the tricuspid, or the semilunar valves were most involved. These are the cases of heart disease in which digitalis is the remedy. However, evidence is strong to show that when the muscular insufficiency can be corrected in these cases then the remedy will do good service. Dr. Schiller looks upon the drug as a remedy for what is ordinarily termed functional heart disease, when not sympathetic. The heart-action is rapid or abnormally slow, or the rhythm is bad, a condition common in school children at puberty when forced to overstudy. Strophanthus is well endorsed as a remedy for the irritable heart of tobacco smokers, masturbators, and those addicted to the use of alcoholics and narcotics.

Acute endocarditis and the reflex palpitation of neurasthenic, hysterical, and chlorotic subjects have been signally benefited by strophanthus, while it appears to give better cardiac power during or after typhoid and other adynamic fevers, when heart failure threatens. It should be remembered as a remedy for threatened cardiac failure in any disease. Full doses should be given for the relief of angina pectoris, and the remedy should be continued for a period after the attack. It is less efficient, because slower in action, than amyl nitrite or nitroglycerin, but may be given for more permanent effects after the evanescent action of these agents has passed off. In pulmonary congestion and in acute bronchitis or acute pneumonia it may be employed when there is deficient heart-action.

Strophanthus has been praised for prompt results in cardiac asthma and bronchial asthma, with oedema; in whooping-cough it has many advocates; it assists the action of iron salts in pernicious anemia and is credited with the cure of traumatic tetanus. Goitre is asserted to have been cured with it, and large doses (8 to 25 drops several times a day) have been said to cure a large proportion of cases of exophthalmic goitre, with irregular cardiac action. Dr. S. Schiller reports great relief to the heart symptoms in two cases of exophthalmic goitre, with disappearance of the bronchocele in one case (Annual of Eclectic Med. and Surg., Vol. I, p. 40). Strophanthus has also been lauded as a remedy for chronic nephritis, with albuminuria, in anasarca, and in ascites from hepatic cirrhosis. It is of little value in oedema and other forms of dropsy or kidney-affections unless dependent upon cardiac disorders. Dr. W. E. Bloyer (Ec. Med. Jour., 1897, p. 51) reports a case of anasarca in which 5-drop doses, every 2 hours, produced an enormous flow of urine and thin alvine discharges, completely draining the tissues in less than 12 hours. Finally, strophanthus is given credit for the cure of a large number of cases of Asiatic cholera, and it has been asserted useful in urticaria and psoriasis.

This agent does not take the place of digitalis, each having its own field of action. It may, however, follow the use of other heart tonics, and particularly those evanescent in action, as amyl nitrite and nitroglycerin. As it does not affect the caliber of the vessels it may be used in preference to digitalis when it is not desirable to add extra work to the heart. It is well borne by the aged and by children. Wilcox (see Ec. Med. Jour., 1897, p. 394) sums up the advantages of strophanthus over digitalis as follows: "Greater rapidity, modifying pulse-rate within an hour; absence of vaso-constrictor effects; greater diuretic power; no disturbance of digestion; absence of cumulation; greater value in children; great safety in the aged." He further summarizes its uses as follows: "All cases in which we wish to establish compensation; all cases of arterial degeneration in which a remedy which causes more energetic cardiac contraction is required; all cases of cardiac disease where diuresis is necessary; all cases of weak or irritable hearts; all cases of cardiac disease in childhood or old age." These we would qualify by adding when the heart-muscle is at fault.

Strophanthus should be avoided or very cautiously used in advanced muscular degeneration, in pronounced mechanical defects of the heart, and in fully and over-compensated hearts. There is great variation in strength in various batches of tincture of strophanthus owing to lack of uniformity in the crude drug employed. The dose of tincture of strophanthus is from 1 to 10 drops; of specific strophanthus, 1/2 to 10 minims; of strophanthin, 1/500 to 1/60 grain. All of which should be cautiously administered.

Specific Indications and Uses.—Weak heart, due to muscular debility; muscular insufficiency; rapid pulse, with low blood pressure; cardiac pain, with dyspnoea.

Related Principles and Preparations.—UKAMBIN. If not identical with Kombé arrow-poison, this substance is at least closely related. The active crystalline principle belongs to the digitalis group, and produces death by arresting cardiac action.

EXUJA or ECHUGIN.—Said to be derived from Adenium Boehmianum (Nat. Ord.—Leguminosae), and employed as an arrow-poison by southwest African Ovambos. Its active principles were found to be a glucosid whose physiological effects were much like those produced by strophanthin, and a resinous substance (echugon). The glucosid echugin (C5H8O2) forms small, satiny, colorless plates insoluble in ether but easily dissolved by water and alcohol. It constitutes about 10 per cent of exuja, which is an odorless, very bitter, blackish-brown crumbly mass.

HIPPO and VAKAMBA.—The Sakayes and Somangs of Africa employ these two arrow-poisons. They induce emesis and tetanic convulsions and paralyze both heart and lungs simultaneously. The action of vakamba, however, is less tetanic, though the effects upon the muscle are observed sooner than with hippo (Laborde).

OUABAÏO.—A poison said to be derived from Carissa Schimperi, A. De Candolle (Acokanthera Schimperi [De C.], Bentham and Hooker; A. Ouabaio, Cathelineau). Arnaud (1888) obtained therefrom an active principle ouabaïn (C30H46O12) a very poisonous, amorphous glucosid which he also obtained from Strophanthus glaber to the extent of nearly 5 per cent (Pharm. Jour. Trans., Vol. XIX, 1888-89, pp. 162 and 606). It resembles strophanthin chemically, and is intensely deadly, 1/65-grain reputed to have been fatal. Locally it is reputed tenfold more powerful than cocaine as a local anaesthetic. It kills by its action upon the lungs and heart. It has been proposed as a remedy for whooping-cough (1/500 grain), but is evidently too dangerous a poison to be employed in such a malady.

ONOBAIO.—This arrow-poison is used by the inhabitants of Obok, situated on the Gulf of Aden. It occurs in small, brown resinous balls. Small doses of it arrest pulmonary action; large doses promptly arrest the action of both heart and lungs.

DAJAKSH.—The Borneo arrow-poison paralyzes the heart (Braidwood).

INCASSA POISON.—An ordeal bark of Africa said to be a violent heart-poison (Liebreich). (For other arrow and ordeal poisons, see under Nux Vomica.)