Reserpine digitalis

Drugs nitroglycerine, hydralazine, oral contraceptives, reserpine, theophylline, digitalis, estrogens, ergotamine, corticosteroids, or caffeine withdrawal... 

Gleaning from herbal medicine the genesis of pharmacology (digitalis salicylic acid—aspirin morphine quinine artemisinin reserpine taxol). Ancient history-present. 

Herbs have been used as medical treatments since the beginning of civilization and some herbal derivatives (e.g., aspirin, reserpine, and digitalis) have become a mainstay of human pharmacotherapy. For cardiovascular diseases, herbal treatments have been used in patients with congestive heart failure, systolic hypertension, angina pectoris, atherosclerosis, cerebral insufficiency, venous insufficiency, and arrhythmia. Scientific validation of several plant species has proved the efficacy of the botanicals in reducing the... 

Traditional or indigenous medicinal therapeutics has developed since before history in all societies. It comprises a mass of practices varying from the worthless to highly effective remedies, e.g. digitalis (England), quinine (South America), reserpine (India), atropine (various countries). It is the task of science to find the gems and to discard the dross, and at the same time to leave intact socially valuable supportive aspects of traditional medicine. 

When one considers the therapeutic impact of morphine, quinine, digitalis, ergot, atropine, cocaine, reserpine, and vincaleukoblastine, to name but a few, it is evident how great is the debt of medicine to plant-derived drugs even today. If one adds the synthetic derivatives and variants of plant-derived products, the role of natural products from plant sources has been most impressive. 

To better understand certain aspects of the mechanism of digitalis drugs, it would be useful to outline briefly their cardiovascular properties. The increased force of myocardial contraction produced by these glycosides is by far their most dramatic pharmacodynamic property. This positive inotropic (increased contractile force) action translates into increased cardiac output and effects on cardiac size and blood volume through diuresis (i.e., the relief of the edema that accompanies CHF). The rate of tension development is apparently affected, not the length of time during which contraction is maintained by the muscle fiber. Digitalis exerts its effect even in the presence of p-blockers or reserpine. 

Not understood. A possible explanation is that because the rauwolfia alkaloids deplete the neurotransmitter from the sympathetic nerve supply to the heart, the parasympathetic vagal supply (i.e. heart slowing) has full rein. Digitalis also causes bradycardia which in the presence of the rauwolfia becomes excessive. In this situation the rate could become so slow that ectopic foci, which would normally be swamped by a faster, more normal beat, begin to fire, leading to the development of arrhythmias. Syncope could also result from the combination of bradycardia and the hypotensive effects of reserpine. 

Lown B, Ehrlich L, Lq)schultz B, Blake J. Effect of digitalis in patients receivii reserpine. Circulation (1961) 24,1185-91... 

Reserpine and tricyclic antidepressants are mutually antagonistic, the normal amine stores needed for the proper action of the antidepressant being altered by the reserpine (12 ). The long-term use of reserpine may influence atrioventricular conduction a variable effect upon PA and AH intervals after iv. administration was seen, depending on the degree of norepinephrine release and the direct depressive action of the reserpine (81 ). The combination of reserpine with digitalis therapy can predispose to cardiac arrhythmias (23 ). 

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