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• Overview

  Reserpine is an indole alkaloid found in the roots of Rauwolfia serpentina and R. vomitoria^[1]. It is an antipsychotic, and antihypertensive drug that used for the control of high blood pressure and for the relief of psychoticsymptoms^[1-4]. However, its adverse effects have limited its clinical use^[4]. The antihypertensive actions of reserpine results from its ability to deplete catecholamines(among other monoamine neurotransmitters) from peripheral sympathetic nerve endings^[2-4]. Moreover, reserpine also has a peripheral action in many parts of the body, resulting in a preponderance of the effects of the cholinergic part of the autonomous nervous system on the GI tract, smooth muscles, blood vessels, etc^[4]. ;

• Indications

  Reserpine is a drug used for the treatment of hypertension^{[4, 5,7, 8]} and schizophrenia[although rarely used nowadays]^{[4, 6]}. It can also be used as an anticholinergic drug to combat excessive cholinergic activity in many parts of the body as well as parkinsonism^[9]. Reserpine can be used as sedative for horses in veterinary field. It is used as a long-acting tranquilizer to subdue excitable or difficult horses and has been used illicitly for the sedation of show horses, for-sale horses, and in other circumstances where a "quieter" horse might be desired^[10]. In addition, it can be used frequently as a highly useful analytic reference standard in the field of mass spectrometry owing to its availability, ease of ionization under electrospray conditions and stability in solution^[11]. ;

• Mode of action

  Reserpine is an adrenergic blocking agent used to treat mild to moderate hypertension through disrupting the normal process norepinephrine vesicular storage. The antihypertensive actions of Reserpine are a result of its ability of depleting catecholamines from peripheral sympathetic nerve endings^[12-14]. These substances are normally involved in controlling heart rate, force of cardiac contraction and peripheral resistance. Reserpine takes effect through inhibition of the ATP/Mg2+ pump responsible for the sequestering of neurotransmitters into storage vesicles located in the presynaptic neuron^[13]. The neurotransmitters that are not sequestered in the storage vesicle are readily metabolized by monoamine oxidase[MAO] causing a reduction in catecholamines^{[12, 14]}. ;

• Adverse reactions

  Some common adverse reactions of reserpine include dizziness, feeling sleepy, dry mouth, headache, muscle pain, stuff nose, upset stomach or throwing up, loose stools, anxiety, weight gain and nosebleed^{[15, 16]}. More severe adverse reactions could occur as allergic reactions(such as rash, hives, itching, red, swollen, blistered with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat), chest pain or pressure, low mood(nervousness, suicidal mood, emotional ups and downs and anxiety), enlarged breasts, breast soreness, bad dreams, not hungry, swelling, lowered interest in sex, hearing loss, shortness of breath, trouble controlling body movements, pain when passing urine^[16]. ;

• Warning and precautions

  Patients of the following conditions should be disabled: being allergic, depression history, a history of suicidal thought, a stomach ulcer, ulcerative colitis and who are subjecting to treatment with electroconvulsive therapy. Patients should also seek advice from the doctors if he/she has gallstones, kidney disease, or a history of stomach problems or slow digestion, plan or has already become pregnant. Since reserpine can pass into breast milk and may do harm to a nursing baby, breast-feed is not allowed during taking this drug. Reserpine is only allowed for use in people older than 18 years old^[16]. ;

• References

  1. https://www.drugbank.ca/drugs/DB00206
  2. Doyle, A. E., E. G. Mcqueen, and F. H. Smirk. "Treatment of hypertension with reserpine, with reserpine in combination with pentapyrrolidinium, and with reserpine in combination with Veratrum alkaloids." Circulation11.2(1955]:170.
  3. Hughes, W. M., E. Dennis, and J. H. Moyer. "Treatment of hypertension with oral reserpine alone and in combination with hydralazine or hexamethonium. " American Journal of the Medical Sciences229.2(1955]:121-134.
  4. The Columbia Encyclopedia, Sixth Edition. Copyright © 2001-05 Columbia University Press.
  5. Kurland, A. A. "Comparison of chlorpromazine and reserpine in treatment of schizophrenia; a study of four hundred cases. " A.m.a.archives of Neurology & Psychiatry 75.5(1956]:510-513.
  6. Braun, M. "Reserpine as a therapeutic agent in schizophrenia. " American Journal of Psychiatry 116.3(1960]:744.
  7. Shamon SD, Perez MI[2009]. "Blood pressure lowering efficacy of reserpine for primary hypertension". Cochrane Database of Systematic Reviews. 4[4]: CD007655.
  8. Chobanian AV, Bakris GL, Black HR, et al.[2003]. "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report". JAMA. 289[19]: 2560–72.
  9. Sharma, V. K., Harik, S. I., Ganapathi, M., Busto, R., & Banerjee, S. P.[1979]. Locus ceruleus lesion and chronic reserpine treatment: effect on adrenergic and cholinergic receptors in cerebral cortex and hippocampus. Experimental Neurology, 65(3], 685-690.
  10. http://www.wedgewoodpetrx.com/learning-center/professional-monographs/reserpine-for-veterinary-use.html
  11. Sharaf ElDin, M. M., et al. "Validated liquid chromatography-tandem mass spectrometry method for simultaneous determination of clopamide, reserpine and dihydroergotoxine: Application to pharmacokinetics in human plasma. " Journal of Pharmaceutical & Biomedical Analysis125(2016]:236-244.
  12. Tsunoda, I.[1965]. A study on hypertension effects of reserpine and monoamine oxidase inhibitors on blood pressure and blood plasma catecholamines. Jpn J Nephrol, 7(3], 361-371.
  13. Ahmed, N. A., Radwan, N. M., Al-Zahaby, A. S., & Abd el-Salam, M. M.[1997]. Reserpine effects on neurotransmitters in chick heart during growth. Journal of Physiology Paris, 91(2], 81.
  14. Häggendal, J., & Malmfors, T.[2010]. The effect of nerve stimulation on catecholamines taken up in adrenergic nerves after reserpine pretreatment. Acta Physiologica, 75(1-2], 33-38.
  15. AJ Giannini, HR Black. Psychiatric, Psychogenic, and Somatopsychic Disorders Handbook. Garden City, NY. Medical Examination Publishing, 1978. Pg. 233. ISBN 0-87488-596-5.
  16. https://www.drugs.com/sfx/reserpine-side-effects.html ;

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