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April 3, 1996

Digoxinlike Toxicity and Death From a Purported Aphrodisiac-Reply

Author Affiliations

New York City Poison Control Center

JAMA. 1996;275(13):988. doi:10.1001/jama.1996.03530370026024

In Reply.  —Bufadienolides and cardenolides are classes of cardioactive steroids with similar steroid nuclei that differ only in the size of their lactone ring. Digoxin and most other plant-derived cardiac glycosides are cardenolides. Dr Pierach is correct that bufadienolides are also found in some plants. Plant-derived bufadienolides are cardiac glycosides, whereas toadderived bufadienolides have no sugar moiety and therefore are cardiac genins.1 We use the inclusive term "cardioactive steroids" to refer to both cardiac genins and cardiac glycosides. Details of our analysis of "LoveStone" were excluded from the MMWR report for editorial reasons. We have shown that this compound is identical to the Chinese medicine "Chan Su," which is produced from toad venom. The bufadienolides identified in this product were cardiac genins found in toad venom and were not cardiac glycosides as would be found in plants. Therefore, we believe that this product is dried toad venom.We agree