lanatoside c

Action and Spectrum

Actions and Spectrum: 

lanatoside C is a cardiac glycoside, a class of compounds known for their effects on the heart and their use in treating certain heart conditions. lanatoside C is specifically derived from Digitalis lanata, a plant commonly known as woolly foxglove.  

Action: 

Positive Inotropic Effect: like other cardiac glycosides, lanatoside C has a positive inotropic effect on the heart. This means it increases the force of heart muscle contraction, leading to a stronger heartbeat. This effect is particularly beneficial in conditions where the heart’s pumping ability is weakened, such as congestive heart failure. 

Negative Chronotropic Effect: It also has a negative chronotropic effect, which slows down the heart rate. This can be useful in conditions like atrial fibrillation, where the heart rate is irregular and too fast. 

Spectrum: 

lanatoside C primarily acts on the myocardium, the heart’s muscular tissue. 

Its effects are not limited to a specific part of the heart but affect the entire myocardium. 

lanatoside C is used in treating congestive heart failure and certain arrhythmias, which helps improve the heart’s efficiency in pumping blood. 

Its spectrum of action is mainly within the cardiovascular system, and its therapeutic use is focused on treating heart-related conditions. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Dizziness 

Facial pain 

Vomiting 

Anorexia 

Abdominal pain 

Disturbance in colour vision 

Nausea 

Mental confusion 

Headache 

Bad dreams 

Convulsions 

Diarrhoea 

Delirium 

Disorientation 

Fatigue 

Blurred vision 

Hallucinations 

Thrombocytopenia 

Gynaecomastia 

Black Box Warning

Black Box Warning: 

None 

Contraindication / Caution

Contraindication/Caution: 

Contraindication 

• Hypersensitivity: lanatoside C should not be used in hypersensitive individuals allergic to it or other cardiac glycosides. Allergic reactions can range from mild-severe anaphylactic reactions. 
• Ventricular Fibrillation: lanatoside C is contraindicated in cases of ventricular fibrillation, a life-threatening arrhythmia characterized by chaotic and ineffective contractions of the heart’s lower chambers (ventricles). Using lanatoside C in such cases can worsen the arrhythmia and lead to cardiac arrest. 
• Ventricular Tachycardia: lanatoside C should be avoided in patients with ventricular tachycardia, another potentially life-threatening arrhythmia characterized by rapid, abnormal ventricular contractions. 
• Heart Block: It should be used cautiously or avoided in patients with certain types of heart block (e.g., complete heart block) because lanatoside C can further slow down the heart’s electrical conduction system, potentially leading to bradycardia or cardiac arrest. 
• Hypokalemia: lanatoside C can increase the risk of arrhythmias when serum potassium levels are low (hypokalemia). Therefore, it is generally contraindicated in patients with severe hypokalemia. 
• Hypocalcemia: Hypocalcemia (low blood calcium levels) can potentiate the toxic effects of lanatoside C on the heart. Therefore, it should be used cautiously or avoided in individuals with severe hypocalcemia. 
• Certain Medications: lanatoside C can interact with other medications, such as antiarrhythmics and diuretics. These interactions may leads to an increased risk of arrhythmias or toxicity. Therefore, it’s essential to consider potential drug interactions before prescribing lanatoside C. 
• Severe Cardiomyopathy: lanatoside C may not be suitable for individuals with severe cardiomyopathy, as it can exacerbate heart muscle dysfunction. 
• Electrolyte Imbalances: Patients with significant electrolyte imbalances, including hyperkalemia (high blood potassium levels) and hypercalcemia (high blood calcium levels), should use lanatoside C cautiously. 

Caution 

• Dosage and Monitoring: lanatoside C dosing requires careful consideration and individualization. Healthcare providers should start with the lowest effective dose and titrate upward while closely monitoring the patient’s response. Frequent monitoring of serum potassium and creatinine levels is essential to avoid toxicity. 
• Renal Impairment: lanatoside C is primarily excreted through the kidneys. Patients with impaired renal function might have a reduced ability to eliminate the drug, increasing the risk of toxicity. Dosing adjustments may be necessary in these cases. 
• Hepatic Impairment: Hepatic dysfunction can affect clearance, although the liver does not primarily metabolize lanatoside C.  
• Electrolyte Imbalances: Patients with electrolyte imbalances, especially hypokalemia (low potassium levels) or hyperkalemia (high potassium levels), should be corrected before starting lanatoside C therapy. Electrolyte levels should be closely monitored during treatment. 
• Hypomagnesemia: Hypomagnesemia (low magnesium levels) can enhance the toxic effects of lanatoside C. Correction of magnesium levels may be necessary before starting treatment. 
• Drug Interactions: lanatoside C can interact with other medications, potentially leading to adverse effects. Some drugs, such as diuretics and antiarrhythmics, can alter lanatoside C’s effects. Healthcare providers should carefully assess potential drug interactions and adjust doses accordingly. 
• Age and Sensitivity: Elderly patients may be more sensitive to the effects of lanatoside C because of the age-related changes in drug metabolism and excretion. Lower doses and more cautious monitoring are often required. 
• Pregnancy and Breastfeeding: lanatoside C should be used during the pregnancy condition only when the potential benefits outweigh the risks. It can pass into breast milk, so its use should be carefully considered during breastfeeding. 
• Electrolyte Balance: Patients taking lanatoside C should maintain a stable electrolyte balance, particularly potassium and calcium levels, as imbalances can increase the risk of toxicity. 
• Digitalis Toxicity: Patients receiving lanatoside C should be educated about the signs and symptoms of digitalis toxicity, including nausea, vomiting, visual disturbances, and arrhythmias. They should promptly report any unusual symptoms to their healthcare provider. 
• Hydration: Adequate hydration is important while using lanatoside C, especially in patients with conditions that may lead to dehydration (e.g., heart failure). 
• Dietary Considerations: Patients should be advised to maintain a consistent dietary potassium intake and avoid drastic diet changes, which can affect lanatoside C’s response. 

Pregnancy / Lactation

Pregnancy consideration:  

US FDA pregnancy category: Not assigned. 

Lactation:   

Excreted into human milk: Not known. 

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 
• Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence, these categories of drugs need to be avoided by pregnant women.    
• Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology: 

lanatoside C is a cardiac glycoside medication derived from Digitalis lanata. Its pharmacological actions primarily involve the inhibition of the sodium-potassium pump (Na+/K+ ATPase) in myocardial cells, increasing intracellular sodium and calcium concentrations. This increases myocardial contractility, making it a positive inotropic agent that strengthens cardiac muscle contractions.

Additionally, lanatoside C has a negative chronotropic effect, slowing down the heart rate through its action on the cardiac conduction system. These combined effects are useful in conditions like congestive heart failure and certain arrhythmias. However, the narrow therapeutic window of lanatoside C necessitates careful dosing and monitoring to avoid toxicity, making it imperative for healthcare providers to administer and manage its use judiciously. 

Pharmacodynamics: 

Mechanism of action: like other cardiac glycosides, lanatoside C exerts its pharmacological effects primarily through a well-defined mechanism of action involving inhibiting the sodium-potassium pump (Na+/K+ ATPase) in cardiac muscle cells.  

Inhibition of Na+/K+ ATPase: 

The primary target of lanatoside C within cardiac muscle cells is the sodium-potassium pump (Na+/K+ ATPase), an enzyme in the cell membrane. 

Normally, this enzyme is responsible for actively pumping sodium (Na+) out of the cell and also potassium (K+) into the cell, maintaining the proper balance of these electrolytes and the resting membrane potential. 

lanatoside C binds to the Na+/K+ ATPase and inhibits its activity. It specifically binds to the alpha subunit of the enzyme. 

Inhibition of the Na+/K+ ATPase disrupts the normal ion-pumping function, accumulating sodium ions within the cell. 

Intracellular Sodium Accumulation: 

The accumulation of sodium ions within the cardiac muscle cell leads to an enhance in intracellular sodium concentration. 

This elevated intracellular sodium concentration indirectly affects another transporter, the sodium-calcium exchanger (Na+/Ca2+ exchanger). 

The sodium-calcium exchanger normally functions to exchange sodium ions for calcium ions. When there is an increase in intracellular sodium due to Na+/K+ ATPase inhibition, more calcium ions are exchanged into the cell. 

Increased Intracellular Calcium Concentration: 

The net effect of Na+/K+ ATPase inhibition is an enhance in intracellular calcium ion concentration ([Ca2+]i) in cardiac muscle cells. 

Calcium ions plays a key role in muscle contraction. Elevated intracellular calcium levels enhance the force of myocardial (heart muscle) contractions, leading to increased contractility (positive inotropic effect). 

Enhanced Cardiac Contractility: 

The increased intracellular calcium concentration results in stronger and more coordinated heart muscle contractions. 

This positive inotropic effect leads to improved cardiac output and the ability of the heart to generally pump the blood more effectively. 

Negative Chronotropic Effect: 

In addition to its inotropic effect, lanatoside C has a negative chronotropic effect, reducing the heart rate. 

This effect is mainly due to its influence on the cardiac conduction system, particularly in slowing down electrical impulses through the atrioventricular (AV) node, which can be beneficial in conditions like atrial fibrillation and atrial flutter. 

Pharmacokinetics: 

Absorption 

lanatoside C is primarily administered orally, typically through tablets or elixirs. 

Its absorption from the gastrointestinal tract is variable and can be influenced by food in the stomach and gastrointestinal motility. 

The rate and extent of absorption may vary among individuals. 

Distribution 

After absorption, lanatoside C is distributed throughout the body, including to the cardiac muscle (myocardium). 

It has a relatively large volume of distribution, which means it distributes extensively into body tissues. 

lanatoside C binds to cardiac muscle fibers, where it exerts its therapeutic effects on myocardial contractility. 

Metabolism 

lanatoside C is metabolized to some extent in the liver, although it is not extensively metabolized like other drugs. 

The primary metabolic pathway for lanatoside C involves hydroxylation and conjugation reactions. 

The metabolites formed are less pharmacologically active than the parent compound. 

Elimination and Excretion 

The primary route of excretion for lanatoside C is through the kidneys. 

The drug is eliminated via renal excretion, with a significant portion being excreted unchanged in the urine. 

The elimination half-life of lanatoside C can vary among individuals but is generally within 24 to 48 hours. 

Adminstartion

Administration: 

lanatoside C, like other cardiac glycosides, should be administered with great care and precision, as it has a narrow therapeutic window and may be toxic if not used appropriately.  

Prescription and Dosing: 

lanatoside C should only be prescribed by a qualified healthcare provider experienced in its use. 

The dosing of lanatoside C should be individualized based on the patient’s age, weight, renal function, and specific cardiac condition. 

The initial dose is typically lower than the maintenance dose to assess the patient’s response and potential side effects. 

Dosing is usually given once daily in most cases. 

Oral Administration: 

lanatoside C is available in oral forms, such as tablets or elixirs. 

Administer the medication exactly as the healthcare provider prescribes, typically with or immediately following a meal. 

Intravenous Administration (in emergencies): 

Intravenous administration of lanatoside C is reserved for critical situations when rapid effects are required, such as in cases of severe heart failure or life-threatening arrhythmias. 

Only healthcare professionals experienced in intravenous administration should give lanatoside C via this route. 

A loading dose may be administered intravenously, followed by maintenance therapy with the oral form. 

Intravenous administration should be performed with caution and constant monitoring of the patient’s heart rhythm and vital signs. 

Monitoring: 

Monitoring the patient’s clinical status is crucial while on lanatoside C therapy. Electrocardiogram (ECG) monitoring is necessary to assess the heart’s rhythm and any signs of arrhythmias. 

Routine measurement of serum electrolytes, including potassium and calcium, is important to ensure the patient’s electrolyte balance remains stable. 

Signs of Toxicity: 

Patients should be generally educated about the signs and symptoms of lanatoside C toxicity, including nausea, vomiting, diarrhea, visual disturbances, confusion, and cardiac arrhythmias. 

Patients should report any unusual symptoms promptly to their healthcare provider. 

Adjustments and Discontinuation: 

Dose adjustments may be necessary based on the patient’s response and serum levels of lanatoside C. 

lanatoside C therapy may be discontinued if toxicity occurs or there is no clinical benefit. 

Hydration and Diet: 

Adequate hydration should be maintained during lanatoside C therapy. 

Drug Interactions: 

Healthcare providers should carefully assess potential drug interactions when prescribing lanatoside C. Adjustments to other medications may be necessary. 

Patient Education: 

Patients should be thoroughly educated about the importance of adherence to their lanatoside C regimen and the need for regular follow-ups with their healthcare provider. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: 

Why do we use  

lanatoside C is a medication in the class of drugs known as cardiac glycosides. It is derived from Digitalis lanata, a plant commonly known as woolly foxglove. lanatoside C has been used for its therapeutic effects on the heart, primarily in treating certain cardiovascular conditions.  

Congestive Heart Failure (CHF): 

lanatoside C has historically treated congestive heart failure (CHF). It helps improve cardiac output by increasing the force and efficiency of the heart’s contractions. This can lead to better circulation and reduced symptoms of heart failure, like SOB (shortness of breath) and swelling. 

Atrial Fibrillation and Atrial Flutter: 

lanatoside C may be used to manage atrial fibrillation and atrial flutter, two abnormal heart rhythms originating in the heart’s upper chambers (atria). It can slow down the heart rate in these conditions, making it more regular and controlled. 

Supraventricular Tachycardia (SVT): 

lanatoside C may treat certain types of supraventricular tachycardia, particularly when other antiarrhythmic medications are ineffective or contraindicated. 

Digitalis Toxicity Reversal: 

In cases of digitalis toxicity, which can occur when patients take too much digitalis-derived medication (including lanatoside C), it can be used to help reverse the toxic effects. In such situations, it’s often administered along with other supportive measures.