Yes

Rauwolfia Alkaloid

Management of mild to moderate hypertension

C

Hypersensitivity to reserpine or any component; depression (especially with suicidal tendencies); active peptic ulcer; ulcerative colitis; patients receiving electroconvulsive therapy

Use extreme caution in treating patients with a history of depression; watch for signs and symptoms of depression. Discontinue at the first sign of depression. Use cautiously in patients with a history of PUD (increases GI motility and secretion) or gallstones (biliary colic may be precipitated). Preoperative withdrawal does not ensure circulatory stability. Make anesthesiologist aware of medical regimen. Avoid in severe renal impairment. Avoid use with monoamine oxidase inhibitors.

Cardiovascular: Peripheral edema, arrhythmias, bradycardia, chest pain, PVC, hypotension

Central nervous system: Dizziness, headache, nightmares, nervousness, drowsiness, fatigue, mental depression, parkinsonism, dull sensorium, syncope, paradoxical anxiety

Dermatologic: Rash, pruritus, flushing of skin

Gastrointestinal: Anorexia, diarrhea, dry mouth, nausea, vomiting, increased salivation, weight gain, increased gastric acid secretion

Genitourinary: Impotence, decreased libido

Hematologic: Thrombocytopenia purpura

Ocular: Blurred vision

Respiratory: Nasal congestion, dyspnea, epistaxis

Symptoms of overdose include hypotension, bradycardia, CNS depression, sedation, coma, hypothermia, miosis, tremors, diarrhea, vomiting

Hypotension usually responds to I.V. fluids or Trendelenburg positioning. If unresponsive to these measures, the use of a parenteral inotrope may be required (eg, norepinephrine 0.1-0.2 mcg/kg/minute titrated to response). Anticholinergic agents may be useful in reducing the parkinsonian effects and bradycardia.

MAO inhibitors: Reserpine may cause hypertensive reactions; use an alternative antihypertensive.

Protect oral dosage forms from light

Reduces blood pressure via depletion of sympathetic biogenic amines (norepinephrine and dopamine); this also commonly results in sedative effects

Onset of antihypertensive effect: Within 3-6 days

Duration: 2-6 weeks

Absorption: Oral: ~40%

Distribution: Crosses the placenta; appears in breast milk

Protein binding: 96%

Metabolism: Extensively in the liver, >90%

Half-life: 50-100 hours

Elimination: Principal excretion in feces (30% to 60%) and small amounts in urine (10%)

Oral (full antihypertensive effects may take as long as 3 weeks):

Adults:

Hypertension: 0.1-0.25 mg/day in 1-2 doses; initial: 0.5 mg/day for 1-2 weeks; maintenance: reduce to 0.1-0.25 mg/day

Psychiatric: Initial: 0.5 mg/day; usual range: 0.1-1 mg

Elderly: Initial: 0.05 mg once daily, increasing by 0.05 mg every week as necessary

Dosing adjustment in renal impairment: Cl_cr <10 mL/minute: Avoid use.

Dialysis: Not removed by hemo- or peritoneal dialysis; supplemental dose is not necessary.

Blood pressure, standing and sitting/supine

catecholamines (U)

Currently, reserpine is used only infrequently for treatment of hypertension. An important side effect is drowsiness. It is important that reserpine be discontinued at least 1 week before elective electroshock therapy.

No information available to require special precautions

>10% of patients experience dry mouth

Take as directed; do not discontinue without consulting prescriber. May take up to 2 weeks to see effects of therapy. Avoid alcohol and maintain recommended diet. You may experience nervousness, dizziness, or fatigue; use caution when driving or engaging in hazardous activities until response to drug is known. Rise slowly from sitting or lying position until response to therapy is known. Small frequent meals or sucking lozenges may reduce nausea or loss of appetite; adequate dietary fruit, fluids, and fiber may reduce constipation. You may experience nasal stuffiness; avoid OTC medications, and consult prescriber. You may experience impotence; will resolve when medication is discontinued. Report chest pain, rapid heartbeat or palpitations, difficulty breathing, sudden increase in weight, swelling in ankles or hands, black tarry stools; or unusual feelings of depression. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Consult prescriber if breast-feeding.

Observe for mental depression and alert family members to report any symptoms

Tablet: 0.1 mg, 0.25 mg

Adelman AM, Daly MP, and Michocki RJ, "Alternate Drugs," Clin Geriatr Med, 1990, 6(2):423-44.

Rogal PP, Rakitin VA, Boichak MP, et al, "Fatal Reserpine Poisoning," Sud Med Ekspert, 1989, 32(1):51-2.

Zsoter TT, Johnson GE, DeVeber GA, et al, "Excretion and Metabolism of Reserpine in Renal Failure," Clin Pharmacol Ther, 1973, 14(3):325-30.