Reserpine adverse effects

Levodopa interacts with many different drugs. When levodopa is used with phenytoin, reserpine, and papaverine, there is a decrease in response to levodopa The risk of a hypertensive crisis increases when levodopa is used with the monoamine oxidase inhibitors (see Chap. 31). Foods high in pyridoxine (vitamin B6) or vitamin B6 preparations reverse the effect of levodopa However, when carbidopa is used with levodopa, pyridoxine has no effect on the action of levodopa hi fact, when levodopa and carbidopa are given together, pyridoxine may be prescribed to decrease the adverse effects associated with levodopa... 

Dopamine antagonist activity is the hallmark of classical neuroleptics. The antihypertensive agents, reserpine (obsolete) and a-methyldopa, deplete neuronal stores of the amine. A common adverse effect of dopamine antagonists or depletors is parkinsonism. 

Pseudoephedrine (Sudafed, Novafed, Afrinol, Others) [OTC] [Decongestant/Sympothomimetic] Uses Deconge tant Action Stimulates a-adren gic rec tors w/ vasoconstriction Dose Adults. 30-60 mg PO q6—8h Peds. 4 mg/kg/24 h PO qid -1- in renal insuff Caution [C, +] Contra Poorly controlled HTN or CAD, w/MAOIs Disp Tabs, caps, Liq SE HTN, insomnia, tach, arrhythmias, nervousness, tremor Interactions T Risk of HTN crisis W/ MAOIs T effects W/BBs, sympathomimetics X effects W/TCAs -1- effect OF methyldopa, reserpine EMS Found in many OTC cough/cold pr >arations use sympathomimetics w/ caution, may T adverse effects OD May cause N/V, HTN, arrhythmias, and Szs symptomatic and supportive... 

Reserpine, an alkaloid extracted from the roots of an Indian plant, Rauwolfia serpentina, was one of the first effective drugs used on a large scale in the treatment of hypertension. At present, it is rarely used owing to its adverse effects. 

Reserpine depletes cerebral dopamine by preventing intraneuronal storage (see Chapter 6) it is introduced in low doses (eg, 0.25 mg daily), and the daily dose is then built up gradually (eg, by 0.25 mg every week) until benefit occurs or adverse effects become troublesome. A daily dose of 2-5 mg is often effective in suppressing abnormal movements, but adverse effects may include hypotension, depression, sedation, diarrhea, and nasal congestion. Tetrabenazine (12.5-50 mg orally three times daily) resembles reserpine in depleting cerebral dopamine and has less troublesome adverse effects it is now available in the USA. Treatment with postsynaptic dopamine receptor blockers such as phenothiazines and... 

Donatelli A, Geisen L, Feuer E. Case report of adverse effect of reserpine on tardive dyskinesia. Am J Psychiatry 1983 140(2) 239-40. 

Depression is a very common adverse effect of reserpine (SED-9, 328) (595). 

The Rauwolfia alkaloids, including reserpine, are now little used. They act by depleting neurotransmitter stores of catecholamines and reducing sympathetic nervous activity, but their effects are non-specific, and nervous system adverse effects (depression, drowsiness, tiredness, confusion) are prominent. There is also a troublesome incidence of diarrhea, hjrperprolactinemia, gynecomastia, and a possible withdrawal syndrome. 

Most adverse effects of reserpine are due to its effect on the CNS. Sedation and inability to concentrate or perform complex tasks are the most common adverse effects. More serious is the occasional psychotic depression that can lead to suicide. Depression usually appears insidiously over many weeks or months and may not be attributed to the drug because of the delayed and gradual onset of symptoms. Reserpine must be discontinued at the first sign of depression, which may last several months after the drug is discontinued. The risk of depression is likely dose related. Depression appears to be uncommon, but not unknown, with doses of 0.25 mg/day or less. The drug should never be given to patients with a history of depression. Other adverse effects include nasal stuffiness and exacerbation of peptic ulcer disease, which is uncommon with small oral doses. 

Reserpine is sometimes used in the treatment of hypertension. In addition to depleting vesicular stores of norepinephrine in sympathetic nerve endings, reserpine depletes brain dopamine and causes parkinsonism-like adverse effects. Reserpine also decreases vesicular stores of norepinephrine and serotonin in CNS neurons, which can result in depression of mood. The answer is (E). 

Reserpine has been used in the management of mild to moderate hypertension, but because of very significant CNS adverse effects and its cumulative action in the adrenergic neurons, reserpine is rarely used. Reserpine and related Rauwolfia alkaloids have been used in the symptomatic treatment of agitated psychotic states, such as schizophrenic disorders, although other antipsychotic agents generally have replaced reserpine and the alkaloids. 

The common adverse CNS effects for reserpine include drowsiness, fatigue, or lethargy. Mental depression is one of the most serious potential adverse effects for reserpine, which may be severe enough to require hospitalization or result in suicide attempts. Reserpine-induced depression may persist for several months after the drug is discontinued. 

Drug-induced lupus is a major adverse effect of procainamide and hydralazine.Iso-lated case reports have incriminated other compounds such as reserpine, methyl-... 

In a series of analogues (53) showed a pronounced antidepressant profile. It counteracted reserpine (depression in mice and emesis in pigeons) and potentiated the action of amphetamine. The position of the alkanoyl residue seemed to be very specific. Small variations of the propionyl moiety abolished the antidepressant activity and (in some cases) gave other effects e.g. depressive with Et CHOH- and hypotensive with EtSOi- [156]. Compound (53) was well tolerated and showed no particularly adverse effect in humans in a 4-wk study at 40-80 mg daily. Ginical studies in patients have been started [157]. 

Tetrabenazine was synthesized in the 1950s as part of research into compounds with reserpine-Uke activity and was initially used in the treatment of schizophrenia. Its common reversible adverse effects include drowsiness/sedation, weakness, parkinsonism, depression, and acute akathisia. 

In a Cochrane systematic review of four randomized controlled trials (all conducted over three decades ago) reserpine was effective in reducing systolic blood pressure as a first-line agent [118 ]. The number of patients included in these trials was small (237), and none of the trials reported withdrawals because of adverse reactions. 

Patients taking certain systemic medications are also more sensitive to the pressor effects of phenylephrine. In individuals taking atropine, the pressor effect of phenylephrine is augmented, and tachycardia can occur. Tricyclic antidepressants and monoamine oxidase (MAO) inhibitors also potentiate the cardiovascular effects of topical phenylephrine. The concomitant use of phenylephrine is contraindicated with these agents, even up to 21 days after cessation of MAO inhibitor therapy. Similarly, patients taking reserpine, guanethidine, or methyldopa are at increased risk for adverse pressor effects from topical phenylephrine because of denervation hypersensitivity accompanying the chemical sympathectomy. 

Reserpine produces sedative, hypotensive, and tranquilizing effects. This is due to its actions of causing depletion of monoamines from presynaptic nerve terminals in central and peripheral nervous systems. The adverse side effects are drowsiness, nightmare, depression, excessive salivation, nausea, diarrhea, increased gastric secretion, abdominal cramps, and hypotension. 

---