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CARDIOVASCULAR SYSTEM › ANTIHYPERTENSIVES › ANTIHYPERTENSIVES AND DIURETICS IN COMBINATION › Rauwolfia alkaloids and diuretics in combination
rescinnamine and diuretics
C02LA02
Forms & Strengths
- Rescinnamine 0.1 mg / Hydrochlorothiazide 15 mg oral tablets
- Rescinnamine 0.25 mg / Benzthiazide oral tablets
- Combination antihypertensive formulations (historically available)
Adult Dosing
- Hypertension: 1 tablet daily to twice daily, titrated based on blood pressure response
- Individual component titration recommended prior to fixed-dose combination therapy
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
Indications
- Management of essential hypertension
- Step-2 antihypertensive therapy when single agents are insufficient
Mechanism of Action
- Rescinnamine: Rauwolfia alkaloid that depletes catecholamines and serotonin in central and peripheral adrenergic neurons, reducing sympathetic tone, peripheral vascular resistance, and heart rate
- Diuretic: Inhibits sodium and chloride reabsorption in the distal renal tubules, promoting diuresis, reducing plasma volume, and decreasing peripheral resistance
Contraindications
- Known hypersensitivity to rescinnamine, Rauwolfia alkaloids, sulfonamide-derived drugs, or diuretics
- Active peptic ulcer disease or ulcerative colitis
- History of mental depression, especially with suicidal tendencies
- Severe renal impairment, anuria, or hepatic coma
Adverse Reactions
- Central nervous system: Severe depression, lethargy, drowsiness, nightmares, extrapyramidal symptoms
- Gastrointestinal: Peptic ulceration, activation of peptic ulcer, nausea, vomiting, diarrhea, dry mouth
- Cardiovascular: Bradycardia, orthostatic hypotension, arrhythmias
- Metabolic/Electrolyte: Hypokalemia, hyperuricemia, hyperglycemia, hypercalcemia (due to thiazide component)
- Other: Nasal congestion, impotence, hypersensitivity rashes
Drug Interactions
- MAO inhibitors: May cause CNS excitation and hypertension; must be separated by at least 2 weeks
- Digitalis glycosides: Concomitant rescinnamine-induced bradycardia or diuretic-induced hypokalemia may precipitate arrhythmias
- Lithium: Diuretics decrease renal lithium clearance, increasing the risk of lithium toxicity
- Anesthetics and antihypertensives: May potentiate hypotensive effects
- NSAIDs: May attenuate the antihypertensive and diuretic efficacy
Curated Content: Needs Vetting Before Put to Clinical Use