Reserpine
From DrugPedia: A Wikipedia for Drug discovery
Reserpine/Hydralazine Hydrochloride/Hydrochlorothiazide
Pronouncation: (reh-SER-peen/high-DRAL-uh-zeen HIGH-droe-KLOR-ide/high-droe-klor-oh-THIGH uh-zide)
Class: Antihypertensive combination
Trade Names:
Hydrap-ES
- Tablets 15 mg hydrochlorothiazide, 0.1 mg reserpine, and 25 mg hydralazine HCl
Trade Names:
Ser-Ap-Es
- Tablets 15 mg hydrochlorothiazide, 0.1 mg reserpine, and 25 mg hydralazine HCl
Contents |
[edit] Mechanism of Action
[edit] Pharmacolog
Reserpine
Depletes stores of catecholamines and 5-hydroxytryptamine, resulting in decreased heart rate and lowering of arterial BP.
Hydralazine
Directly relaxes vascular smooth muscle to cause peripheral vasodilation, decreasing arterial BP, and peripheral vascular resistance.
Hydrochlorothiazide
Increases chloride, sodium, and water excretion by interfering with transport of sodium ions across renal tubular epithelium.
[edit] Indications and Usage
Treatment of hypertension.
[edit] Contraindications
Hypersensitivity to any components of product; hypersensitivity to sulfonamide-derived drugs; mental depression or history of mental depression; active peptic ulcer; ulcerative colitis; patients receiving electroconvulsive therapy; coronary artery disease; mitral valvular rheumatic heart disease; anuria.
[edit] Dosage and Administration
Adults
PO Dosage should be determined by individual titration (max, 0.25 mg reserpine/day).
[edit] Storage/Stability
Store tablets at controlled room temperature (59° to 86°F).
[edit] Drug Interactions
Reserpine Digoxin, quinidine
Risk of cardiac arrhythmias may be increased.
Direct- (eg, epinephrine) and indirect- (eg, amphetamines) acting amines
The effects of direct-acting amines may be prolonged while the effects of indirect-acting amines may be inhibited.
MAO inhibitors
Avoid concurrent use or use with extreme caution.
Tricyclic antidepressants
Antihypertensive effects of reserpine may be decreased.
Hydralazine MAO inhibitors
Use with caution.
Potent parenteral antihypertensive agents (eg, diazoxide)
Profound hypotensive episodes may occur.
Hydrochlorothiazide Insulin
Insulin requirements may be increased, decreased, or unchanged.
Lithium
Renal clearance of lithium may be decreased, increasing the risk of toxicity.
Methyldopa
The risk of hemolytic anemia may be increased.
Norepinephrine
Arterial responsiveness may be decreased by hydrochlorothiazide.
NSAIDs (eg, indomethacin)
The diuretic, natriuretic, and antihypertensive effect of hydrochlorothiazide may be reduced.
Tubocurarine
Responsiveness to tubocurarine may be decreased.
Laboratory Test Interactions
Hydrochlorothiazide
May decrease serum protein-bound iodine levels without signs of thyroid disturbances. May cause diagnostic interference of serum electrolyte levels, blood and urine glucose levels, serum bilirubin levels, and serum uric acid levels.
[edit] Adverse Reactions
Cardiovascular
Arrhythmias; syncope; angina-like symptoms; bradycardia; edema; angina pectoris; hypotension; paradoxical pressor response; tachycardia; palpitations; orthostatic hypotension.
CNS
Parkinsonian syndrome and other extrapyramidal tract symptoms; dizziness; headache; paradoxical anxiety; depression; nervousness; nightmares; dull sensorium; drowsiness; disorientation; peripheral neuritis including paresthesia; numbness and tingling; tremors; vertigo; xanthopsia; weakness; restlessness.
EENT
Nasal congestion; deafness; optic atrophy; glaucoma; uveitis; conjunctival injection; conjunctivitis; lacrimation; transient blurred vision.
GI
Vomiting; diarrhea; nausea; anorexia; dry mouth; hypersecretion; paralytic ileus; constipation; pancreatitis.
Genitourinary
Pseudolactation; impotence; dysuria; gynecomastia; decreased libido; breast engorgement; difficulty in urination.
Hematologic
Blood dyscrasias including reduction in hemoglobin and RBCs; leukopenia; agranulocytosis; lymphadenopathy; splenomegaly; eosinophilia; aplastic anemia; thrombocytopenia.
Hepatic
Hepatitis; jaundice (intrahepatic cholestatic); sialadenitis; vomiting; diarrhea; cramping; nausea; gastric irritation; constipation; anorexia.
Metabolic
Hyperglycemia ;glycosuria; hyperuricemia.
Respiratory
Dyspnea; epistaxis; pneumonitis; pulmonary edema.
Miscellaneous
Muscular aches; flushing; muscle cramps; arthralgia; muscle spasm; hypersensitivity (including necrotizing angiitis, Stevens-Johnson syndrome, purpura, urticaria, rash, pruritus); photosensitivity.
[edit] Precautions
Pregnancy
Category C .
Lactation
Reserpine and hydrochlorothiazide are excreted in breast milk.
Children
Safety and efficacy not established.
Special Risk Patients
Use with caution in patients with severe renal disease, impaired hepatic function, peptic ulcer, ulcerative colitis, or gallstones.
Postsympathectomy patients
Drug may enhance antihypertensive effects.
Systemic lupus erythematosus (SLE)
Hydralazine may produce an SLE-like reaction while hydrochlorothiazide may exacerbate or activate SLE.
[edit] Overdosage
Symptoms
Impaired consciousness including drowsiness, coma, flushing, conjunctival injection, papillary constriction, hypotension, hypothermia, central respiratory depression, bradycardia, increased salivary and gastric secretions, diarrhea, tachycardia, headache, generalized skin flushing, myocardial ischemia, MI, cardiac arrhythmia, profound shock, loss of fluid and electrolytes, shock, weakness, confusion, dizziness, cramps of calf muscles, paresthesia, fatigue, vomiting, nausea, thirst, polyuria, oliguria, anuria, hypokalemia, hyponatremia, hypochloremia, alkalosis, increased BUN.
[edit] Patient Information
- Explain name, dose, action, and potential side effects of drug.
- Advise patient to take prescribed dose daily, without regard to meals but to take with food if GI upset occurs.
- Inform patient that drug controls, but does not cure, hypertension and to continue taking medication as prescribed even when BP is not elevated.
- Caution patient not to change the dose or stop taking unless advised to do so by health care provider.
- Instruct patient to continue taking other BP medications as prescribed by health care provider.
- Instruct patient in BP and pulse measurement skills.
- Advise patient to monitor and record BP and pulse at home and to inform health care provider should abnormal measurements be noted. Also advise patient to take record of BP and pulse to each follow-up visit.
- Instruct patient to lie or sit down if experiencing dizziness or lightheadedness when standing.
- Caution patient that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting can lead to excessive fall in BP resulting in lightheadedness or fainting.
- Instruct diabetic patient to monitor blood glucose more frequently when drug is started or dose is changed and to inform health care provider of significant changes in readings.
- Caution patient to avoid unnecessary exposure to UV light (sunlight, tanning booths) and to use sunscreen and wear protective clothing when exposed to UV light to avoid photosensitivity reaction.
- Emphasize to hypertensive patient importance of other modalities on BP: weight control, regular exercise, smoking cessation, and moderate intake of alcohol and salt.
- Advise women to notify health care provider if pregnant, planning to become pregnant, or breastfeeding.
- Instruct patient to immediately report any of these symptoms to health care provider: depression, drowsiness, weakness, decreased urination, or rapid heart rate.
- Advise patient that follow-up visits and lab tests may be required to monitor therapy and to keep appointments.
