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CARDIOVASCULAR SYSTEM › ANTIHYPERTENSIVES › ANTIHYPERTENSIVES AND DIURETICS IN COMBINATION › Rauwolfia alkaloids and diuretics in combination
rauwolfia alkaloids, whole root and diuretics
C02LA08
Forms & Strengths
- Combination tablet: Rauwolfia serpentina whole root 50 mg / Bendroflumethiazide 4 mg
- Combination tablet: Rauwolfia serpentina whole root 50 mg / Trichlormethiazide 4 mg
Adult Dosing
- Hypertension: 1 tablet daily to twice daily based on clinical response and titration requirements
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
Indications
- Management of essential hypertension
Mechanism of Action
- Rauwolfia alkaloids deplete catecholamines and serotonin in central and peripheral adrenergic neurons, reducing sympathetic tone, heart rate, and blood pressure
- Diuretic component (thiazide) inhibits sodium reabsorption in the distal renal tubules, promoting diuresis and reducing peripheral vascular resistance
Contraindications
- Known hypersensitivity to rauwolfia alkaloids, thiazides, or sulfonamide-derived drugs
- Active peptic ulcer disease
- Ulcerative colitis
- History of mental depression, especially with suicidal tendencies
- Anuria
- Severe renal impairment
Adverse Reactions
- Depression, drowsiness, fatigue, nightmares
- Nasal congestion, dryness of mouth
- Hypotension, bradycardia
- Hypokalemia, hyperuricemia, hyperglycemia, hypercalcemia
- Diarrhea, nausea, vomiting, peptic ulcer activation
Drug Interactions
- MAO inhibitors: May cause CNS excitation and severe hypertension; avoid concurrent use
- Digitalis glycosides: Thiazide-induced hypokalemia increases risk of digitalis toxicity
- Lithium: Thiazides reduce lithium renal clearance, increasing toxicity risk
- Antihypertensives: Additive hypotensive effects
- Skeletal muscle relaxants (nondepolarizing): Potentiation of neuromuscular blockade by thiazides
Curated Content: Needs Vetting Before Put to Clinical Use