UTube Presentations available: Ouabain (Stropanthin-G) in Cardiovascular
Medicine - Integrative Practitioner Version
Benefits of Ouabain (g-Stropanthin) in Cardiovascular Disease
With a high degree of confidence, and based upon my review of the scientific and clinical literature, I can state that:
A. Ouabain is of significant and documented value in:
1. Reducing symptoms and increasing effort capacity in
patients with symptomatic, obstructive coronary artery disease.
2. Improving functional status in patients with heart failure
on the basis of pump dysfunction (prior heart attack or cardiomyopathy) or
valvular insufficiency.
3. Rapidly resolving symptoms in patients with microvascular
ischemia (due to faulty Na+/K+-ATPase ion pump function).
4. Improving functional status in patients with atrial
fibrillation, while providing a modest reduction in heart rate.
B. Ouabain is an endogenous molecule, the ligand of Na+/K+-ATPase
(functioning as a receptor and not just as an ion pump). As such with oral
dosing (3 mg three times a day) the use of
Ouabain is safe and there are no
adverse interactions with other drugs, other than:
a) As your physiology improves, it
may be necessary to decrease the dose of the drugs that you are taking.
b) While co-administration of Ouabain
and digoxin is described in older, untranslated German papers, there is at least
a theoretical potential for antagonism (Ouabain has been used to
reverse
digoxin toxicity); as such I am advising against their concomitant use.
C. 98% of US physicians (including this one until recently) are unaware of the
benefits of Ouabain or incorrectly liken Ouabain to digoxin, and thus
(inappropriately) fear Ouabain toxicity.
The statements below (under D) are given with a little reservation, as
they are based on:
a) Excerpts or summaries of German papers that have not been
translated (thus not read in full by myself).
b) Studies of Ouabain in animal models of CV (cardiovascular)
disease conditions.
D. Ouabain is of value in:
1. Reducing mortality and improving outcome in acute
myocardial infarction (heart attack); here 6 mg of Ouabain is taken with the
onset of heart attack pain.
2. Chronic Ouabain use will reduce muscle loss if a treated
patient does experience a heart attack.
3. Pre-op Ouabain improves outcome in on-pump open heart
surgery.
4. Ouabain may protect against the development of heart
failure in pressure overload (hypertension, aortic stenosis) cardiac strain
states.
5. Improving mood and sense of optimism.
6. Improving athletic performance.
7. Differentiating cardiac from non-cardiac symptoms in the
physician's office (the Stropanthin "quick test"). I am using this with my own
patients.
Therapeutic Ouabain, a standardized extract of the African plant Stropanthus
gratus, is available through European natural product compounding pharmacies (we
use stropantil.com). The standard dose is 3 mg three times a day.
Concomitant food intake will compromise Ouabain absorption, and thus we
recommend that Ouabain be take one hour before or two hours after meals. Ideally
the capsule is opened, the powder dispersed within your mouth with a little
water, and then swallowed (the longer the powder is in your mouth, the faster it
will enter your circulation). The stropantil.com people recommend
increasing the dose to 6 mg three times a day. This is likely safe but to this
point my patients have stayed at the 3 mg level. As Ouabain is a natural
product and not manufactured by US pharmaceutical concerns, there are no
regulatory constraints with respect to you obtaining Ouabain from Europe or any
other source. During the current Covid-19 pandemic, delivery time has been
variable, up to four weeks, so please plan ahead.
The mechanisms through which Ouabain provides these above described clinical
benefits (more in depth discussion in later sections), include the ability of
Ouabain to:
A. Increase cardiac energy generation (ATP) without a concomitantly
increase in oxygen consumption.
B. Increased cardiac contractility (pump function) also without an
increase in oxygen need.
C. Delay or prevent the generation of lactic acid when the heart is
strained metabolically.
D. Improve the uptake and assimilation of glucose (synergizing with
insulin) when aerobic (oxygen requiring) energy generation is compromised.
E. Stimulate the parasympathetic limb of the autonomic nervous system
(lowering heart rate and energy needs) while restraining the sympathetic (fight
or flight) limb (which raises heart rate, blood pressure, and risk of
arrhythmia).
E. "Condition" the mitochondria, lessening the risk of energy failure and cell
loss (apoptosis) when the heart is stressed by oxygen insufficiency,
catecholamine (adrenalin) excess, or infection/inflammation.
F. Improve endothelial function (in vitro animal studies).
Ouabain (Stropanthin-G) is a safe and effective approach to macro and micro-vascular ischemia and heart failure. Interacting with the alpha subunit of the membrane-bound Na+, K +-ATPase, Ouabain initiates several tyrosine kinase cascades. Calcium availability for contraction relaxation cycling is enhanced, but as mitochondrial metabolism is stimulated, oxygen utilization is spared. Ouabain provides for mitochondrial conditioning (as does exercise and episodic ischemia), and in the setting of oxygen deprivation enhances glycolytic metabolism while blunting lactic acid build-up. Parasympathetic activity is enhanced, and thus modest HR slowing occurs in the setting of atrial fibrillation. Hyperinsulinemia down regulates ATPase activity, leading to red cell and platelet sodium accumulation and swelling, compromising trans-capillary flow. Ouabain rapidly restores ATPase function, cell size normalizes, and microvascular ischemia (if due to ATPase dysfunction) is relieved. Ouabain is an endogenous molecule, generated in the adrenal cortex, hypothalamus, and placenta. Placental Ouabain deficiency is associated with small for gestational age birth and renal maldevelopment. Unlike digoxin, Ouabain (unless given in excessive dose IV) does not inhibit the ATPase, and thus “digitalis toxicity” can not occur. There are no down sides to Ouabain, and this agent can be given along with other cardioactive agents. The standard dose of Ouabain is 3-6 mg, tid, po or preferably sl, best taken on an empty stomach. Ouabain can be obtained from European compounding pharmacies, from their North American distributors, and health care providers without a prescription.
James C. Roberts MD FACC FAARFM 8/23/20
How to Order Ouabain (Stropanthus) May '21
A. European website: https://www.optisan.info
Choose Shop from the dropdown menu and chose what you wish to order. This is the
most economical way to get Ouabain. The price is around $66 USD plus
shipping for 100 capsules. The optisan product was previously marketed as
Stropantil.
B. US Source: https://drtomcowan.com Go to the "Shop" dropdown menu a tt he top and choose "Stropanthus". Click on Buy Stropanthus now. Under Stropanthus capsules choose view product and order what you need. Current cost here is $105 plus shipping for 100 capsules.
C. Contact Herbeso in Canada via e-mail: csiepe@lyranara.com In the e-mail give them the quantity you want, along with your name, address and phone number. They will call you to get your credit card information and will ship a supply of Ouabain to you directly. They request that you respond within 1 day of their request with payment (as they will spend time and energy preparing your order). Two bottles of 100 tablets each will cost $180 plus $23 shipping = $203
D. Our personal patients can obtain their initial Ouabain supplies in the office: $75 for European Optisan and $120 for tablets/capsules from other sources.
If you are aware of other sources of Ouabain, we would appreciate hearing about this. We want to get good quality Ouabain in your hands at the lowest possible price.
James C. Roberts MD FACC FAARFM 1/18/21
You Tube Presentation References – Studies cited in the presentation are in bold type
Ischemic Heart Disease
1. Effects of Ouabain on Myocardial Oxygen Supply and Demand in Patients with Chronic Coronary Artery Disease. DeMots, H. et. al. The Journal of Clinical Investigation Vol. 58, Aug. 1976, pp. 312-319.
2. Clinical, electrocardiographic, and haemodynamic effects of digitalis (ouabain) in angina pectoris. Sharma, B. et. al. British Heart Journal, 1972, 34, 631-637.
3. Neuere Therapie der instabilen Anginapertoris bei koronarer Herzerkrankung, Erfahrungsheilkunde. R.E. Dormann and M. Dormann. Acta Medica Empirica 33:183-190, 1984.
4. Klinisch-poliklinische Studie
uber die Wirksamkeit von g-Stropanthin bei Angina pectoris und myokardonfarkt.
R. E. Dormann, H. D. Janish, and M. Kessel. Cardiol bull 14/15: 183-187, 1977.
5.
Therapeutische Ergebnisse bei akutem Myokardinfarkt unter Anwendung
hoch-dosierter Steroidgaben und fluiditätsbeeinflussender Pharmaka - Ergebnisse
einer 10-Jahres-Studie. R.E.Dohrmann & R.F.Heller . Cardiol Bull 24: 17, 1987.
6. Prof. Quantiliano de Mesquita, Professor Honorario de Faculdade de Medicina de Universidade Federal de Paraiba. Chefo do Instituto de Angio Cardiologia de Hospital Matarazzo e Cas de Saude Matarazzo Sao Paulo: Teoria miogenico do enfarte miocardio. Verlag: Gemini, Sao Paulo (Brasilien), 1979, in Rundbrief 42 der Int.Gesellschaft für Infarktbekämpfung, Febr.1980 (später umbenannt in Gesellschaft für Infarktbekämpfung, weitere Umbenennung in Gesellschaft für Infarktverhütung. Sitz: Schorndorf-Haubersbronn, ausleihbar in Bilbliotheken (evtl. Fernleihe).
7. F.Kubicek, Th.Reisner: Hypoxietoleranz bei koronarer Herzkrankheit unter der Einwirkung von Digoxin, ß-methyl-Digoxin und g-Strophanthin, Ther d.Gegenw (Therapie der Gegenwart) Heft 5 1973, S.747-768.
8. Infarktvorbeugung in der Arbeitsmedizin,. H. Brenbach. Notabene Medici 7: 613-616, 1984
9. Eine Dokumentation ambulanzkardiologischer Therapie-Ergebnisse nach Anwendung oralen g-Strophanthins, Herbert Pharma GmbH, Wiesbaden, 1984
10. Eichholtz, F, Lehrbuch der Pharmakologie, fifth edition, Berline und Heidelberg, Springer Verlag, 1947.
11. Effect of Ouabain on the Left ventricular Response to Exercise in Patients with Angina Pectoris. Glancy, D. et. al. Circulation Vol XLIII, Jan. 1971 45-57.
12. Research on the Mechanism of Myocardial Infarctions and on Counteracting Measures A new galenic Form of the Fast Acting g-stropanthin, M. Von Ardenne. Agressologie 1978, 19, 1:13-22.
13. Comparison of the effects of Ouabain and Isoproterenol on Ischemic Myocardium of Conscious Dogs. Vatner, S. et. al. Circulation Vol. 58, No. 4, Oct. 1978 pp 654-662.
14. Eine Dokymentation ambulanzkardiologischer Therapie-Ergebnisse nach Anwendung oralen g-Strophanthins, Herbert Pharma GmbH, Wiesbaden, 1984.
15. H. Salz & B. Schneider: perlinguales
g-Stropanthin bei stabiler Angina pectoris, Z Allg Med (Zeitschrift fur
Allgemeinmedizin) 61: 1223-1228, 1985.
Microvascular Ischemia
1. Animal and Human Tissue Na,K-ATPase in Obesity and Diabetes: A New Proposed Enzyme Regulation. Iannello, S. et. Al. Am J Med Sci 2007;333(1):1-9.
2. Insulin-resistant Na+ Pump Activity in Adipocytes From Obese Humans. Mott, D. et. Al. Am J Physiol, 249 (2 Pt 1); E160-4. Aug 1985.
3. Reduced Activity of the Red-Cell Sodium-Potassium Pump in Human Obesity. Luise, M and Blackburn, G. N Eng J Med, 303 (18), 1017-22. 1980 Oct 30.
4. Decreased Activity of the Red Blood Cell ATPase-dependent Na+ Pump in Patients With Cardiac Syndrome X. Ferri, C. et. al. Clin Sci (Lond), 97 (3), 369-75. Sep. 1999.
Heart Failure
1. Long-Term Use of K-Stropanthin in Advanced Congestive Heart Failure due to dilated Cardiomyopathy: A Double-Blind Crossover Evaluation Versus Digoxin. Giuseppe, P. et. al Clin. Cardiol. 17, 536-541 (1994).
2. Better Efficacy of K-strophanthidin Versus Digoxin in Subjects With Dilated Cardiomyopathy and Chronic Heart Insufficiency. Agostoni, P. G. et. al. Cardiologia 37 (5), 323-9. May 1992.
3. Myocardial region (right or left ventricle) and aetiology of heart failure can influence the inotropic effect of ouabain in failing human myocardium. Padrini, R. et. al. Br J Clin Pharmacol, 48, 743-749.
4. The hemodynamic effects of ouabain upon the diseased left ventricle. Yankopoulos, N. et. al. American Heart Journal Oct, 1968 Vol. 76, No. 4, pp. 466-480.
5. Reductions of myocardial NA-K ATPase activity and ouabain binding sites in heart failure: prevention by nadolol. Fan, T. et. al. Am. J. Physiol. 265 (6 Pt 2) H2086-H2093 Dec. 1993.
6. Myocardial Adenine Nucleotides, Glycogen, and Na, K,-ATPase in Patients With Idiopathic Dilated Cardiomyopathy Requiring Mechanical Circulatory Support. Ishino, K. et. al. Am J Cardiol, 83 (3), 396-9 1999 Feb 1.
7. Relation of Left ventricular Function and Na, K-pump Concentration in Suspected Idiopathic Dilated Cardiomyopathy. Norgaard, A. et. Al. Am J Cardiol, 61 (15), 1312-5 1988 Jun 1.
8. Human myocardial Na, K-ATPase concentration in heart failure. Bundgaard, H. and Kjeldsen, K. Mol Cell Biochem 163/164:277-283, 1996.
9. Studies of Digitalis. X. Effects of Ouabain on Forearm Vascular Resistance and Venous Tone in Normal Subjects and in Patients in Heart Failure. Mason, D. and Braunwald, E. Journal of Clinical Investigation Vol. 43, No. 3, 1965.
10. Increased muscle sympathetic nerve activity predicts mortality in heart failure patients. Barretto, A. et. al. International Journal of Cardiology 135 (2009) 302-307.
11. Rethinking Heart Failure. Furstenwerth, H, Cardiol. Res 2012;3(6):243-257.
13. Ouabain in the Treatment of Shock. Horton, J, and Davison, M. Brit. J. Anesth. (1955), 27, 139.
Ischemia Reperfusion and Ouabain
Conditioning
1. Ischemia/reperfusion induced alteration of enzymatic and signaling functions
of the rat cardiac Na+/K+-ATPase: protection by ouabain
preconditioning. Belliard, A. et. al. Physiological Reports 4(19), 2016, e12991.
2. Ouabain triggers preconditioning through activation of the Na+/K+-ATPase signaling cascade in rat hearts. Pierre, S. et. Al. Cardiovasc Res. 2007 Feb. 1; 73(3):488-496.
3. Recent Advances in Pharmacological and Non-Pharmacologic Strategies of Cardioprotection. Caricate-Neto, A. et. al. Int. J. Mol. Sci. 2019, 20, 4002
4. Na/K-ATPase Signaling and Cardiac Pre/Postconditioning with Cardiotonic Steroids. Marck, P. and Pierre, S. Int. J. Mol. Sci. 2018, 19, 2336.
4. Ouabain Improves Functional Recovery following Traumatic Brain Injury, Dvela-Levitt, M. et. al. Journal of Neurotrauma 31:1942-1947 (Dec. 1, 2014).
5. Stropanthus hispidus attenuates the Ischemia-Reperfusion induced myocardial Infarction and reduces means arterial pressure in renal artery occlusion. Gundamaraju, R. et. al. Pharmacogn Mag. 2014 Aug; 10(Suppl 3): S557-S562.
6. Ouabain – The Key to Cardioprotection? Fuerstenwerth, H, American Journal of Therapeutics 21, 395-402 (2014).
7. Ouabain – the optimal solution for the problem of myocardial infarction
(Extracts from the book “Ouabain – the possible victory over the myocardial infarction” by Rolf-Jürgen Petry*)
http://www.infarctcombat.org/heartnews-17.html
Physiology
1. Proteomics Analysis of the Proliferative Effect of Low-Dose Ouabain on Human Endothelial cells. Qiu, J. et. Al. Biol. Pharm. Bull. 30(2):247-253 (2007).
2. Endogenous and exogenous cardiac glycosides: their roles in hypertension, salt metabolism, and cell growth. Schoner, W. and Scheiner-Bobis, G. Am J Physiol Cell Physiol 293: C509-C536, 2007.
3. New Insights into the Regulation of Na+ ,K+-ATPase by Ouabain. Silva, E. and Soares-da-Silva, P. International Review of Cell and Molecular Biology, Vol. 294.
4. Ouabain, a steroid hormone that signals with slow Calcium oscillations. Aizman, O. et. Al. PNAS Nov. 6, 2001, Vol. 98, No. 23 13420-13424.
5. The Sodium Pump and Cardiotonic Steroids-Induced Signal Transduction. Liu, J. and Xie, Z. Biochim Biophys Acta 2010 December; 1802(12):1237-1245.
6. Ouabain-Like Compound Changes Rapidly on Physical Exercise in Humans and Dogs. Bauer, N. et. al. Hypertension. 2005;45:1024-1028.
7. Ouabain Induces Nitric Oxide Release by a PI3K/Akt-dependent Pathway in Isolated Aortic Rings From Rats With Heart Failure. Siman, F. et. al. J Cardiovasc Pharmacol Vol. 65, No. 1, Jan. 2015 28-38.
8. Ca+2 Oscillation Frequency Regulates Agonist-stimulated NF-kB Transcriptional Activity. Hu, Q. et. Al. The Journal of Biological Chemistry Vol. 274, No. 48, Nov. 28, pp. 33995-33998.
9. Prevention of apoptotic onset rescues from glomerular tubular disconnection and podocyte loss in proteinuric kidney disease. Burlaka, I. et. al. Kidney Int. 2016 July;90(1):135-148.
10. Ouabain protects against adverse developmental programming of the kidney. Li, J. e. al. Nature Communications July 27, 2010.
11. Reduction in Maternal Circulating Ouabain Impairs Offspring Growth and Kidney Development. J Am Soc Nephrol. 2015 May; 26(5):1103-114.
12. Effect of Ouabain on Insulin Secretion in the Dog. Triner, L. et. al. Circulation research, Vol. XXV, Aug. 1969 119-128.
13. The Relationship between the transport of glucose and cations across cell membranes in isolated tissues. Clausen, T. Biochim. Biophysica Acta, 109 (1965) 164-171.
14. Effect of ouabain on insulin secretion in man. Saxton, C. et. al. Clinical Science (1972) 42, 57-62.
15. Insulin Secretion in Heart Failure Sharma, B. British Medical Journal, 1970, 2, 396-398.
16. Differential activation of transcription factors induced by Ca+2 response amplitude and duration. Doimetsch, R. et. al. Nature Vol. 386, 24 April 1997 855-858.
17. Effect of subthreshold ouabain on the tone of guinea-pig aortic strips following repeated noradrenaline stimulation. Bova, S. et. al. Br. J. Pharmacol. (1994), 111, 1067-1072.
18. Signaling pathways involving the sodium pump stimulate NO production in endothelial cells. Eva, A. et. al. Biochimica et Biophysica Axcta 1758 (2006) 1809-1814.
19. Ouabain-regulated phosphoproteome reveals molecular mechanism for Na+/K+-ATPase control of cell adhesion, proliferation, and survival. Ranizza, E. et. al. FASEB J. Sep; 33(9): 10193-10206.
20. Proteomics Analysis of the Proliferative Effect of Low-Dose Ouabain on Human Endothelial Cells. Qiu, J. et. al. Biol. Pharm. Bull. 30(2):247-253 (2007).
21. Protein Kinase G Transmits the Cardioprotective Signal From Cytosol to Mitochondria. Costa, A. et. al. Circulation Research Vol. 97, Issue 4, 19 August 2005, pp 329-336.
22. Ouabain Enhances Basal Release of Nitric Oxide from Carotid Artery. Xie, J. et. al. Am J Med Sci 1993;305(3):157-163.
243. Signal-transducing function of Na+/K+ -ATPase is essential for ouabain’s effect on [Ca2+]i in rat myocytes.
24. Binding of Src to Na+/K+ - ATPase Forms a Functional Signaling Complex. Tian, J. et. al. Molecular Biology of the Cell Vol. 17, 317-326, Jan. 2006
25. Sarcolemmal Na(+)-K(+)-ATPase: Inactivation by Neutrophil-Derived Free Radicals and Oxidants. Kukreja, R. et. al. Am J Physiol. 1990 Nov;259(5 Pt 2):H1330-6.
26. Inhibition of cardiac Sarcolemma Na(+)-K+ ATPase by Oxyradical Generating Systems. Shao, Q. et. al. PMID: 749453.
27. Ouabain prevents pathological cardiac hypertrophy and heart failure through activation of phosphoinositide 3-kinase a in mouse. Wu, J. et. al. Cell Biosci (2015) 5:64.
28. “Oxygen Sensing” by Na,K-ATPase: These Miraculous Thiols. Bogdanova, A. et. al. Frontiers in Physiology Aug. 2016, Vol. 7. Article 314.
29. Cardiac glycosides potently inhibit C-reactive Protein synthesis in human hepatocytes. Kolkhof, P. et. al. Biochemical and Biophysical Research Communications 394 (2010) 233-239
30. Ouabain Affects the Expression of activation Markers, Cytokine Production, and Endocytosis of Human Monocytes. Teixeira, M. and Rumjanek, V. Mediators of Inflammation Vol 2014, Articles ID 760368.
31. Ouabain-induced hypertension is accompanied by increases in endothelial vasodilator factors. Rossoni, L. Am J Physiol Heart Circ Physiol 282: H2110-H2118, 2002.
32. Studies on Digitalis XVII Effects of Ouabain on the Hemodynamic Response to exercise in Patients with Mitral Stenosis in Normal Sinus Rhythm. Beiser, G. et. al. NEJM Vol. 278, No. 3 131-137.
33. The other functions of the sodium pump. Askari, Amir Cell Calcium 84 (2019) 102105
34. The sodium pump and digitalis drugs: Dogmas and fallacies. Askiri, Amir. Pharmacol Res Perspect. 2019;00:e00505.
35. Why isn’t clinical experience with ouabain more widely accepted? Furstenwerth, H. Am J Physiol Heart Circ Physiol 307: H1262-H1263, 2014.
36. Skeletal Muscle Na,K-ATPase as a Target for Circulating Ouabain. Kravtosa, V. et.a l. Int. JH. Mol. Sci. 2020, 21, 2875.
37. Na+ /K+-ATPase as the Target Enzyme for Organic and Inorganic Compounds. Vasic, V. et. al. Sensors 2008, 8, 8321-8360.
38. Stimulation of Monovalent Cation Active
Transport by Low Concentration of Cardiac Glycosides
Role of Catecholamines
Hougen, T. et. al. J. Clin. Invest. Vol. 68, Nov. 1981 1207-1214
39. Evidence for participation of catecholamines in cardiac action of ouabain: Positive Chronotropic Effects. Seifer, E. Br. J. Pharmac. (1974), 51, 481-490.
40. Isoform-specific Stimulation of Cardiac Na/K Pumps by Nanomolar Concentration of Glycosides. Gao, J. et. al. J. Gen. Physiol. Vol. 119 April 2002 297-312.
41. Ouabain interaction with cardiac Na+ /K+-ATPase initiates signal cascades independent of changes in intracellular Na and Ca+2 concentration. Liu, J. et.al. Manuscript M002950200, June 28, 2000. The American Society for Biochemistry and Molecular Biology
42. Signal-transducing function of the Ouabain potentiates the anti-microbial activity of aminoglycosides against Staphylococcus aureus. Kumari, N. BMC Complementary and Alternative Medicine (2019) 19:119.
43. Ouabain uptake by endocytosis in isolated guinea pig atria. Nunez-Duran, H. et. al. Am. J. Physiol. 255 (Cell Phsyiol.24):C479-C485, 1988.
44. Ouabain Protects Mice against Lipopolysaccharide-Induced Acute Lung Injury. Want, C, et. al. Med Sci Monit. 2018; 24: 4455-4464.
45. Modulation of Cytokine Production and Protection against Lethal Endotoxemia by the Cardiac Glycoside Ouabain. Akira, M. et. al. Circulation Vol. 96(5), 2 Sept. 1977 pp. 1501-1506.
46. Improved recovery of cardiac function after hypothermic storage with ouabain. Lagerstrom, C. et. al. J Thorac Cardiovasc Surg 1988;96:782-8.
47. Acidosis-Induced Apoptosis in Human and
Porcine Heart. Thatte, H. et. al. Ann Thorac Surg 2004;77”1376-83.
48. A unique pathway of cardiac myocyte death caused by hypoxia-acidosis.
Graham, R., et. al.
The American Journal of Experimental Biology 207, 3189-3200.
Lactic Acidosis
1. Increased Aerobic Glycolysis Through b2 Stimulation is a Common Mechanism Involved in Lactate Formation During Shock States. Levy, B. et. al. Shock, Vol. 30, No. 4, pp. 417-421, 2008.
2. Relation between muscle Na+/K+ ATPase activity and raised lactate concentration in septic shock: a prospective study. Levy, B. et. al. Lancet 2005; 365: 871-75.
Ouabain vs. Digitalis
1. On the Differences Between Ouabain and Digitalis Glycosides. Fuerstenwerth, H. PhD. American Journal of Therapeutic 21, 35-42 (2014).
2. Ouabain attenuates cardiotoxicity induced by other cardiac steroids. Nesher, M. et. al. British Journal of Pharmacology (2010) 160, 346-354.
3. Ouabain-digoxin antagonism in rat arteries and neurons. Song, H. et. al. J Physiol 592.5 (2014) pp 941-969.
General Information
1. Ouabain – the insulin of the heart. H. Furstenwerth. Int J Clin Pract, November 2010, 64, 12, 1591-1594.
2. Why Whip the Starving Horse When There Are Oats for the Starving Myocardium? Furstenwerth, Hauke PhD. American Journal of Therapeutics 23, e1182-e1187 (2016).
3. Ouabain – a gift from paradise. Hauke Furstenwerth (this book covers the history of Ouabain).
4. Ouabain – Webster’s Timeline History 1864-2007 (cites multiple articles). Professor Phillip Parker.