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What is reserpine?
Reserpine lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels (veins and arteries) to relax (widen) and your heart to beat more slowly and easily. Reserpine is used to treat hypertension (high blood pressure). Reserpine is also sometimes used to treat psychotic states such as schizophrenia. Reserpine may also be used for purposes other than those listed in this medication guide.

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What are the possible side effects of reserpine?

If you experience any of the following serious side effects, stop taking reserpine and seek emergency medical attention:

• an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

• a very irregular heartbeat;

• heart failure (shortness of breath, swelling of ankles or legs, sudden weight gain of 5 pounds or more);

• uncontrollable hand, arm, or leg movements; or

• chest pain.

Other, less serious side effects are more likely to occur. Continue to take reserpine and talk to your doctor if you experience

• fatigue or drowsiness;

• dizziness (avoid standing up too quickly and use caution when performing hazardous activities);

• anxiety, depression, or nightmares;

• diarrhea, nausea, or vomiting (take reserpine with food or milk if it upsets your stomach);

• stuffy nose or a dry mouth (sucking on ice chips or sugarless hard candy may relieve a dry mouth);

• blurred vision;

• weight gain; or

• impotence or difficulty ejaculating.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

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How should I take reserpine?
Take reserpine exactly as directed. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you. Take each dose with a full glass of water. Take reserpine with food or milk if it upsets your stomach. Do not stop taking reserpine suddenly. Stopping suddenly could make your condition much worse or cause very serious side effects. Store this medication at room temperature away from moisture and heat.

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What is the most important information I should know about reserpine?
Use caution when driving, operating machinery, or performing other hazardous activities. Reserpine may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities. Use caution when rising from a sitting or lying position, especially first thing in the morning. You may become dizzy while taking reserpine and you may fall and injure yourself if you get up quickly. Do not stop taking reserpine suddenly. Even if you feel better, you need this medication to control your condition. Stopping suddenly could cause severe high blood pressure, anxiety, and other dangerous side effects.

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What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the dose you missed and take only your next regularly scheduled dose. Do not take a double dose of this medication.

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What other drugs will affect reserpine?
Do not take reserpine if you are taking a monoamine oxidase inhibitor (MAOI) or if you have taken one in the last 14 days. MAOIs, used to treat depression, include isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate). Before taking reserpine, tell your doctor if you are taking any of the following medicines: a tricyclic antidepressant such as amitriptyline (Elavil, Endep), imipramine (Tofranil), doxepin (Sinequan), nortriptyline (Pamelor), and others; quinidine (Cardioquin); or

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Can I take this if I am pregnant or trying to get pregnant or if I am breastfeeding?

Reserpine has been assigned to pregnancy category C by the FDA. Animal studies have revealed evidence of teratogenicity after doses 125 to 250 times the maximum recommended human dose (MRHD, on a per kg basis) were given to rats. Abnormalities included anophthalmia, absence of the axial skeleton, and hydronephrosis. Pregnancy in rabbits was interrupted when doses 10 times the MRHD were given early or late in pregnancy. There are no controlled data in human pregnancy. Reserpine should only be used during pregnancy when there are no alternatives and benefit outweighs risk.

There are three relevant sources of information on the use of reserpine during human pregnancy: a case report and two retrospective studies. In one case, a stillborn female was born at gestation week 30 to a hypertensive, 30-year-old mother who had taken reserpine from days 13 to 41. Abnormalities included cleft lip and palate and bilateral anophthalmia, marked scoliosis, a thoracolumbar open defect, and diaphragmatic agenesis. The mother had also been exposed to tobacco and ampicillin. In response to this case report, Cziezel summarized the Hungarian experience with reserpine from 1980 to 1984. During this period, 52 of 6,227 pregnant women were exposed to reserpine. Neither the total group nor subgroups of congenital anomalies indicated a significant increase associated with reserpine treatment during pregnancy. There was no evidence of any congenital reserpine syndrome. Of 50,282 mother-child pairs monitored by the Collaborative Perinatal Project, 48 had first trimester exposure to reserpine and 475 had exposure to reserpine at anytime during pregnancy. Of the 48, four defects (8%) were observed, which was more than expected. Of the 475, microcephaly (7), hydronephrosis (3), inguinal hernia (12), and hydroureter (3), were observed. None of these anomalies occurred significantly more than expected. Data from the Michigan Medicaid Birth Defects Study failed to reveal an association between reserpine and congenital abnormalities (written communication, Franz Rosa, MD, Food and Drug Administration, 1994). This was a retrospective study of 229,101 completed pregnancies between 1985 and 1992, of which 15 were exposed to reserpine at some time during the first trimester, and 42 were exposed to the drug at any time during pregnancy. No birth defects were observed. These data do not support an association between reserpine and birth defects, although conclusions from this study have not been made based on the small number of pregnancies with known exposure to the drug.

Reserpine is excreted into human milk. There are no reports of adverse effects on the nursing infant.

There are reports of galactorrhea associated with reserpine.

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What does my medication look like?
Reserpine is available in several generic formulations. Brand names include Serpalan and Serpasil. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

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What happens if I overdose?
Seek emergency medical attention. Symptoms of a reserpine overdose include low blood pressure (fainting, dizziness, weakness); slow pulse; low body temperature; diarrhea; and slow breathing.

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Who should not take reserpine?
Do not take reserpine without first talking to your doctor if you have peptic ulcer disease (stomach ulcers); have ulcerative colitis; are suffering from depression (especially if you have suicidal thoughts); are receiving electroconvulsive shock therapy; or are taking a monoamine oxidase inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) or have taken one in the last 14 days. Before taking this medication, tell your doctor if you have gallstones,

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Can I stop taking the medication if I feel better?
Even though you may feel better you should not stop taking your high blood pressure medication without first checking with your healthcare provider.

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I am on so many medications; do I have to take them all?
This is called polypharmacy—many different medications being used at the same time by one person. Sometimes, being on multiple medications is acceptable and appropriate but at other times it may be problematic. If you are receiving your medications from multiple physicians you need to ensure that they all know what medications you are taking. The best way to do this is to make a list of all the medications you are currently using, including all nutritional supplements, homeopathic remedies, vitamins and over-the-counter drugs (if possible, also include all the diseases you have been diagnosed with). Give a copy to every doctor who takes care of you so they have it on file, this way they can avoid duplicating medications and perhaps even try to consolidate some. After every doctor's visit remember to update the list accordingly. Also, as much as you possibly can, try to use the same pharmacy to fill all your prescriptions, this way any potential drug interactions can be caught and averted.

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