Indications
Reserpine is an indole alkaloid extracted from Rauwolfia serpentine roots, an Indian climbing shrub. Reserpine has had FDA approval since 1955 and is one of the first agents developed to treat hypertension in clinical practice. Reserpine can be prescribed alone or combined with a vasodilator or thiazide diuretic, such as reserpine-hydrochlorothiazide, as commonly used in China for over 40 years.[1][2] Reserpine was utilized as a first-line antihypertensive therapy when initially introduced but is currently considered a second-line treatment.[3] This change in status is due to newer and more favorable antihypertensive medications with better side effects. Reserpine is no longer available in the United States. This article is available for historic purposes.
A recent clinical trial tested the effects of reserpine on refractory hypertension (RfHTN) or uncontrolled blood pressure after ≥ five antihypertensive medications from different classes. Out of 45 patients with suspected RfHTN, seven consented to participate in the clinical trial, which only six patients were able to complete.[4] For the trial, patients tapered and discontinued all sympatholytic medications before administering reserpine 0.1 mg daily for four weeks.[4] Treatment results indicate that reserpine is a potent sympatholytic agent that can lower blood pressure in patients who had unsuccessful maximal antihypertensive therapy.[4]
In the 1960s, reports indicated that depression correlated with the monoamine-depleting activity of reserpine treatment, and a neurochemical model of depression was subsequently developed.[5] Recent studies examined the association between reserpine and its depressogenic effect. A case-control, cross-sectional study was conducted from August 2018 to December 2018 to examine the correlation between low-dose reserpine use and depression in Chinese hypertensive patients at the age of 60 and over, with the mean age at 70.3 years.[6] The study utilized the Zung Self-Rating Depression Scale to develop a Chinese depression scale to measure depressive symptoms in 787 reserpine users and 787 non-reserpine users. Researchers found no statistical significance in the prevalence of mild, moderate, or severe depression between reserpine users and non-reserpine users.[6] However, it is important to note that there are limitations to this study, which include utilizing a self-rating depression scale.[6]
Reserpine has historically had other uses. Reserpine was previously utilized to treat schizophrenia and tardive dyskinesia; however, it is not currently in clinical practice for these indications.[7]