Trigoxin: Is it Real or Fake?

Trigoxin matches the name of the drug Digoxin. Digoxin is used to boost the performance, strength of the heart, curbs irregular heartbeat, abnormal pulse, and management of arrhythmias.

The drug trigoxin was mentioned in the movie ‘Run on Hulu’.

In reality, research by Mayo Clinic found that there is no such drug called Trigoxin but the drug which performs the functions described above is called Digoxin. Trigoxin is a fictional drug similar to a real-life drug called Digoxin.


Various Brand of Trigoxin

Trigoxin: Is it Real or Fake?
Trigoxin

Digoxin preparations are marketed under the trade/brand names:

Cardigox; Cardiogoxin; Cardioxin; Cardoxin; Coragoxine; Digacin; Digicor; Digomal; Digon; Digosin; Digoxine Navtivelle; Digoxina-Sandoz; Digoxin-Sandoz; Digoxin-Zori; Dilanacin; Eudigox; Fargoxin; Grexin; Lanacordin; Lanacrist; Lanicor; Lanikor; Lanorale; Lanoxicaps; Lanoxin; Lanoxin PG; Lenoxicaps; Lenoxin; Lifusin; Mapluxin; Natigoxin; Novodigal; Purgoxin; Sigmaxin; Sigmaxin-PG; Toloxin.

Composition of Digoxin

Digitalis is classified as a glycoside composed of 2 parts: glycone (sugar molecule) and an aglycone (cardenolide). The glycone aids easy absorption of the drug into the body thereby increasing the bioavailability.

Cardiac glycosides such as digoxin are closely related to a group of drugs having common specific effects in the myocardium. These drugs affect specific minerals (sodium and potassium) inside heart cells. This helps to reduce heart strains and conserve normal blood flow hence increasing myocardial contraction and reducing the rate of heartbeat. 

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Mechanism of Action of Supposed Trigoxin

A brief change in the voltage across the cell membrane of cardiocytes is called cardiac action potential. This is caused by the movement of positively and negatively charged ions (cations and anions respectively) between the intracellular and extracellular spaces through proteins called ion channels.

Action potential in the myocardium differs from action potential in skeletal and smooth muscles because of the differences in the ion channels as well as other properties of cardiocytes such as autorhythmicity, presence of pacemakers and the conductive system of the heart.

Unlike the action potential in skeletal muscle cells, the cardiac action potential is not initiated by depolarization of nerve cells. Instead, depolarization of the myocardium begins with the pace makers.

Pace makers are a group of specialized cells with the ability to automatically generate voltage. In healthy hearts, these cells are found in the right atrium and are called the sino-atrial node (SA node).

They produce roughly 60-100 action potentials every minute. This action potential passes along the cell membrane through the conductive system that includes the atrioventricular node, Purkinje’s fibres and bundle of His.

The action of the pace makers, conductive system and autorhythmicity of cardiocytes  causes the contraction and relaxation of the myocardium which leads to diastole and systole. All cardiac muscle cells are electrically linked to one another, by structures known as gap junctions which allow the action potential to pass from one cell to the next.

This means that all atrial cells can contract together, and then all ventricular cells. 

The Reaction Mechanism of Digoxin (Trigoxin)

During normal physiological states, sodium ions slowly escapes from the extracellular fluid into the cells, while potassium ions escapes out of the cell due to the electrochemical difference of the two ions across the cell membrane.

Whenever an action potential is generated, additional sodium ion enters the cell, and potassium ion leaves the cell.

The number of ions moving across the sarcolemma membrane in a single action potential is relatively small compared to the total number of ions. Generating action potential repeatedly, causes a significant change in the extracellular and intracellular concentration of these ions.

 An ATP-dependent pump system (sodium ion/potassium ion-ATPase) located on the sarcolemma maintains the concentration gradients for sodium ions and potassium ion, by transporting sodium ions out of the cell and potassium ions back into the cell in the presence of Adenosine Triphosphate (ATP) broken down to Adenosine Diphosphate (ADP) and Phosphate (pi) with the release of energy .

This pump is essential for the maintenance of sodium ion and potassium ion concentrations across the membrane.

If this pump stops working (as occurs under anoxic conditions when ATP is lost), or if the activity of the pump is inhibited (as occurs with cardiac glycosides such as digoxin), sodium ion accumulates within the cell and the concentration of intracellular potassium ion falls.

This causes depolarization of the resting membrane potential as predicted by the Nernst equation primarily because of the reduction in the potassium concentration gradient across the cell membrane. 
Furthermore, it is important to note that this pump is electrogenic in nature because it extrudes three sodium ions for every two potassium ions entering the cell.

By pumping more positive charges out of the cell than into the cell, the pump activity creates a net outward current of positive charges, which creates a negative potential within the cell.

This makes the intracellular fluid more electronegative by almost -10mV. Inhibition of this pump, therefore, causes cellular depolarization resulting not only from changes in sodium ion and potassium ion concentration gradients but also from the loss of an electrogenic component of the resting membrane potential. 
By mechanisms that are not fully understood, digitalis compounds also increase vagal efferent activity to the heart. This parasympathomimetic action of digitalis reduces sinoatrial firing rate (decreases heart rate; negative chronotropy) and reduces conduction velocity of electrical impulses through the atrioventricular node (negative dromotropy).

Uses of Digoxin (Trigoxin)

There is a joke about taking digoxin to cure heart breaks. On a more serious note digoxin is used to handle irregular heartbeat in cases such as atrial fibrillation and atrial flutter with rapid ventricular response usually along with some more high-level medication. It is also used to treat heart failures. 

Administration

Digoxin can be formulated as tablets, capsules, or pediatric elixirs (liquid) to be taken according to prescription. The pediatric elixir (liquid) comes with a specifically marked dropper for measuring the dose. It is advised to always take the same brand of Digoxin because different brands have different amounts and doses. Follow the directions on your prescription level and ask your doctor or pharmacist to explain any part you do not understand.


Side Effects

Dizziness, Drowsiness, vision changes, rash, irregular heartbeat, loss of appetite, upset stomach, unusual weight gain, difficulty breathing

Storage and Disposal

This drug is best stored at room temperature away from excessive heat and moisture. Due to its low therapeutic index it is only administered when prescribed by a certified health professional such as a doctor or pharmacist to avoid toxicity.

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