Drug Interaction:
+ Reserpine-
MAO inhibitors
avoid MAO inhibitors or use with extreme caution
Tricyclic antidepres
concurrent use may decrease the antihypertensive effect of
reserpine
Mephentermine
antihypertensive effects of guanethidine or resrpine may be partially or
totally reversed by the moixed acting sympathomimetics
Reserpine +
Digitalis glycoside/ Quinidine
use reserpine cautiously with digitalis and quinidine, since cardiac
arrhythmias have occured
Sympathomimetics direct acting
closely monitor concurrent use of reserpine and direct or indirect
acting sympathomimetics.The action of direct-acting eg,ephinephrin
Sympathomimetics indirect acting + Rauwolfis alkaloids
isoproternol,phenylephrine, metaraminol ) may be prolonged when
given to patients taking reserpine. The action of indirect-acting
amines (eg. ephedrine, tyramine, amphetamines ) is inhibited
Direct - increased -reserpine potentiates the pressor response of direct acting agents
Mixed - decreased -(eg. epinephrine ) which may result in hypotension. The pressor
response of mixed-acting agents (eg. ephedrine) is decreased
Indication:
FIXED DOSE COMBINATIONS APPROVED BY DCG(I)
FROM JANUARY 1961 TILL NOVEMBER 2014
Name of Drug Indication Date of Approval
Reserpine 0.1mg + June 1972
Clopamide 5mg +
Dihydroergocristine 0.5mg tablet
Hypertension
Antiadrenergic agents ( Peripherally acting )include- Reserpine, Guanithidine monosulphate, Guandrel sulfate, ( Alpha-1- blockers), Prazosin,Terazosin, Doxazosin, Tamsulosin, Silodosin, Alfuzosin Hcl Refer - Prazosin
Adverse Reaction:
GI- Vomiting, diarrhea, nausea, anorexia, dryness of mouth, hypersecretion.
Cardiovascular- Arrhythmias (particularly when used concurrently with digitalis or quinidine), syncope,angina-like symptoms, bradycardia, edema.
Respiratory- Dyspnea, epistaxis, nasal congestion.
CNS- Parkinsonian syndrome and other extrapyrimidal tract symptoms (rare), dizziness, headache, paradoxical anxiety, depression, nervousness, nightmares, dull sensorium, drowsiness.
Special senses- Deafness, optic atrophy, glaucoma,uveitis.
Miscellaneous- hypersentivity reactins, purpura,rash, pruritus, weight gain, muscular aches.
Contra-Indications:
Hypersensitivity, mental depression or history of mental depression, active peptic ulcer,
ulcerative colitis, patients receiving electroconvulsive therapy.
Special precautions:
None reported
Warnings-
Depression- excercise cauton intreating patients with a history of mental depression. Respine may cause mental depression.
Ulcers- since resperine increases GI motility , use with caution in patients with a history of
peptic ulcer, ulcerative colitis or gallstones
Cardiovascuar effects- it is important that the anesthesiologist be aware of the patients drug intake and consider this in the overall management since hypotension has occuredin patients receiving resperine.
Renal funtion impairment- excercise caution whentreating hypertensive patients with renal insufficiency.
Pregnancy- use during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Lactation- use with caution and decide whether to discontinue nursing or the drug depending on the importance of the drug to the mother.
Children- safety and efficacy for use in children have not been established.
Dosages/ Overdosage Etc:
Date of Approval June 1972
Indications:
Hypertension
Dosage:
Hypertension- patients not receiving other antihypertensive agents- usual dosage is 0.5mg daily for 1 or 2 weks.
Maintenance- reduce to 0.1 to 0.25mg daily. Use higher doses cautiously because occurance of serious mental depression and other side effects may increase considerably.
Overdosage- Symptoms No deaths due to acute poisioning with reserpine have been reported. Highest known doses survived impairment of consciousness may occur and may range of overdosage. Flushing of the skin, conjuntivial injection and pupilary constriction are to be expected Hypotension hyperhermia,central respiratory depression and beadycardia may develop in cases of severe overdosage. Increased salivary secretion gastric secretion and diarrhea may also occur .
Treatment
1.There is no specific antidote
2. Evacuate stomach contents,taking adequate precautions against aspiration and for protection of the airway. 3. Activate charcoal slurry should be instilled 4.Treat the effects of resperpine overdosage symptomaticaly 5.If hypotensionis severe enough to require treatment with vasopressor use one having a direct action upon vascular smooth muscle e.g. phenylephirine , nor epinneprine, metaraminol ) 6. Since reserpine is long acting, observe the patient carefully for at least 72 hours. and administer treatment as required.
Missed dose
1. If you miss a dose of this medicine, do not take the missed dose at all.
2. Do not double the next dose.
3. Instead, back to your regular dosing schedule.
Other Information:
Nasal congestion- Drugs causing advesse reactions- ( 386 )
1. Reserpine
2. Guanethidine
3. Isopreternol
4. Oral contraceptives
5. Decongestant abuse
Peptic ulceration -
Drugs causing Adverse Reactions- ( 385 )
1. Aspirin
2. Phenylbutazone
3. Indomethicin
4. Ethacrynic acid
5. Reserpine ( latge doses )
Drowsiness-
Drugs causing adverse reactions- ( 388 )
1. Anxiolytic drugs
2. Major tranquillizers
3. Tricyclic antidepressants
4. Antihistamines
5. Methyldopa
6. Clonidine
7. Reserpine
Patient Information:
1. Inform patients of possible side effects and advice them to take medication regularly and continously as directed
Pharmacology/ Pharmacokinetics:
Antiadrenergic agents ( Peripherally acting )include- Reserpine, Guanithidine monosulphate, Guandrel sulfate, ( Alpha-1- blockers), Prazosin,Terazosin, Doxazosin, Tamsulosin, Silodosin, Alfuzosin Hcl Refer - Prazosin
Pharmacology:
Resrpine depletes stores of catecholamine and 5-hydroxytryptamine in many organs including brain and adrenal medulla. The depression of sympathetic nerve function results in decreased heart rate and lowering of arterial blood pressure. The sedative and tranquilising properties of reserpine are thought to be related to depletion of catecholamine and 5-hydroxytyptamine from the brain.
Pharmacokinetics:
Reserpine is characterised by slow onset of action and sustained effects. Both cardiovascular and CNS effects may persist for a period of time folowing withdrawal of the drug. Plasma levels of reserpine after IV administration declined with a mean half-life of 33 hours. reserpine is extensively bound to plasm proteins.
Interaction with Food:
None reported.
Pregnancy and lactation:
Pregnancy:
Use during pregnancy only if the potential benefits justifies the potential risk to the fetus.
Lactation:
Use with caution and decide whether to discontinue nursing or discontinue the drug taking into consideration the importance of the drug to the mother.
Children- Safety and efficacy for use in children have not been established.
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