Reserpine

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In pharmacology, reserpine is "an alkaloid found in the roots of Rauwolfia serpentina and R. vomitoria. Reserpine inhibits the uptake of norepinephrine into storage vesicles resulting in depletion of catecholamines and serotonin from central and peripheral axon terminals. It has been used as an antihypertensive and an antipsychotic as well as a research tool..."[1]

Efficacy

Hypertension

Reserpine may be an excellent choice for second line therapy for patients who fail diuretics.[2]

Reserpine was a component of combination therapy in several major trials of treating hypertension: the Hypertension Detection and Follow-Up Program (HDFP)[3][4], Multiple Risk Factor Intervention Trial (MRFIT)[5][6], Veterans Administrative Cooperative Study Group in Anti-hypertensive Agents[7], and the Systolic Hypertension in the Elderly Program (SHEP)[8][9].

In a review of reserpine as monotherapy, the Cochrane Collaboration concluded that reserpine can lower the systolic blood pressure by about 8 mm Hg in patients with hypertension.[10]

Adverse effects

In a review of 691 patients in seven studies, McMahon found that 5% of patients discontinued reserpine because of adverse effects. [11]

Case control studies[12] that reported an association between reserpine and breast cancer have been contradicted by cohort studies[13].

American Geriatrics Society 2012 Beers Criteria Update Expert Panel recommends avoiding the use of reserpine (> 0.1 mg/d); however, their basis for this recommendation is not stated.[14]

References

  1. Anonymous (2015), Reserpine (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. Barzilay J, Grimm R, Cushman W, Bertoni AG, Basile J (2007). "Getting to goal blood pressure: why reserpine deserves a second look.". J Clin Hypertens (Greenwich) 9 (8): 591-4. PMID 17673879.
  3. Hypertension Detection and Follow-up Program Cooperative Group (1979). "Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. Hypertension Detection and Follow-up Program Cooperative Group.". JAMA 242 (23): 2562-71. PMID 490882.
  4. Hypertension Detection and Follow-up Program Cooperative Group (1979). "Five-year findings of the hypertension detection and follow-up program. II. Mortality by race-sex and age. Hypertension Detection and Follow-up Program Cooperative Group.". JAMA 242 (23): 2572-7. PMID 490883.
  5. (1982) "Multiple risk factor intervention trial. Risk factor changes and mortality results. Multiple Risk Factor Intervention Trial Research Group.". JAMA 248 (12): 1465-77. PMID 7050440.
  6. (1997) "Multiple Risk Factor Intervention Trial. Risk factor changes and mortality results. Multiple Risk Factor Intervention Trial Research Group. 1982.". JAMA 277 (7): 582-94. PMID 9032168.
  7. Veterans Administrative Cooperative Study Group in Anti-hypertensive Agents (1977). "Propranolol in the treatment of essential hypertension.". JAMA 237 (21): 2303-10. PMID 323525.
  8. Perry HM, Davis BR, Price TR, Applegate WB, Fields WS, Guralnik JM et al. (2000). "Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke: the Systolic Hypertension in the Elderly Program (SHEP).". JAMA 284 (4): 465-71. PMID 10904510.
  9. Curb JD, Pressel SL, Cutler JA, Savage PJ, Applegate WB, Black H et al. (1996). "Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Systolic Hypertension in the Elderly Program Cooperative Research Group.". JAMA 276 (23): 1886-92. PMID 8968014.
  10. Shamon SD, Perez MI (2009). "Blood pressure lowering efficacy of reserpine for primary hypertension.". Cochrane Database Syst Rev (4): CD007655. DOI:10.1002/14651858.CD007655.pub2. PMID 19821434. Research Blogging.
  11. McMahon FG (1978). Management of essential hypertension. Mount Kisco, N.Y.: Futura Pub. Co.. ISBN 0879931086. 
  12. Heinonen OP, Shapiro S, Tuominen L, Turunen MI (1974). "Reserpine use in relation to breast cancer.". Lancet 2 (7882): 675-7. DOI:10.1016/S0140-6736(74)93259-0. PMID 4142957. Research Blogging.
  13. Curb JD, Hardy RJ, Labarthe DR, Borhani NO, Taylor JO (1982 Mar-Apr). "Reserpine and breast cancer in the Hypertension Detection and Follow-Up Program.". Hypertension 4 (2): 307-11. PMID 7040229.
  14. American Geriatrics Society 2012 Beers Criteria Update Expert Panel (2012). "American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults.". J Am Geriatr Soc 60 (4): 616-31. DOI:10.1111/j.1532-5415.2012.03923.x. PMID 22376048. Research Blogging.