Reserpine Side Effects

It is possible that some side effects of reserpine may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

For the Consumer

Applies to reserpine: oral tablet

If you experience any of the following serious side effects, stop taking reserpine and seek emergency medical attention:

  • an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

  • a very irregular heartbeat;

  • heart failure (shortness of breath, swelling of ankles or legs, sudden weight gain of 5 pounds or more);

  • uncontrollable hand, arm, or leg movements; or

  • chest pain.

Other, less serious side effects are more likely to occur. Continue to take reserpine and talk to your doctor if you experience

  • fatigue or drowsiness;

  • dizziness (avoid standing up too quickly and use caution when performing hazardous activities);

  • anxiety, depression, or nightmares;

  • diarrhea, nausea, or vomiting (take reserpine with food or milk if it upsets your stomach);

  • stuffy nose or a dry mouth (sucking on ice chips or sugarless hard candy may relieve a dry mouth);

  • blurred vision;

  • weight gain; or

  • impotence or difficulty ejaculating.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

For Healthcare Professionals

Applies to reserpine: oral tablet

General

In one study of 231 hospitalized patients, 26 (11.3%) reported adverse side effects. Of these 26 patients, three (1.2%) patients developed side effects that were considered life-threatening. Adverse reactions were observed within the first two days of therapy in 62% of patients who experienced side effects.[Ref]

Respiratory

The most common side effect is nasal congestion, reported in 8% of patients. A rare respiratory system side effect is bronchospasm.[Ref]

Rare reports of reserpine-induced bronchospasm are believed to be due to inactivation of beta-adrenergic receptors, which can result in a marked potentiation of the bronchoconstrictive effect of histamine.[Ref]

Nervous system

Increased parkinsonian movements upon reserpine withdrawal (as with neuroleptics) may be due to supersensitivity to dopamine as a result of increased dopamine receptors that developed during reserpine therapy.[Ref]

Common nervous system side effects include sedation, lethargy (different from the psychiatric syndrome of depression), drowsiness, weakness, vertigo, insomnia, or headache in approximately 1% to 5% of patients. While reserpine is used to treat tardive dyskinesia, extrapyramidal movements may worsen upon withdrawal of therapy. A case of CNS hypertension, believed to be due to cerebral edema, has been associated with the use of reserpine.[Ref]

Psychiatric

Psychiatric problems related to reserpine therapy can be serious. Depression occurs in 2% to 28% of patients, is more likely when daily doses exceed 0.5 mg, and can present at any time during therapy. Suicidal ideation has been reported. Reserpine-induced depression is quickly reversible if therapy is withdrawn as soon as the syndrome is recognized, but can persist for several months after drug discontinuation if the syndrome fully develops. Reserpine withdrawal psychosis has been reported.[Ref]

The depressive syndrome usually consists of melancholy, loss of self confidence, early morning awakening, loss of libido, and reduced appetite.

A case of reserpine withdrawal psychosis has been reported. This uncommon condition may be due to dopamine receptor supersensitivity, which develops during reserpine therapy.[Ref]

Gastrointestinal

Due to unopposed parasympathetic activity produced by catecholamine depletion, reserpine increases gastrointestinal motility and secretory activity. Because of this, new diarrhea or worsening of existing diarrhea or increased salivation have been reported in 2% of patients. Increased appetite, abdominal pain, or vomiting have only rarely been reported.[Ref]

Cardiovascular

Cardiovascular side effects include hypotension in 8% and bradycardia (and rare cases of syncope with bradycardia) in 3% of patients. A rare case of paroxysmal atrial tachycardia with block associated with reserpine in a patient who was not taking a digitalis preparation has been reported.[Ref]

A woman with paroxysmal atrial tachycardia developed sinus pauses during reserpine therapy which were reproducible by carotid massage, except when isoproterenol was given. Reserpine is known to increase vagal tone and deplete cardiac catecholamines.

One patient, in a series of 231, had emergent hypertension, stroke, and thyrotoxic crisis. Reserpine 1 mg intramuscularly resulted in a blood pressure drop from 180/100 to an unmeasurable level. The patient recovered after isoproterenol therapy.[Ref]

Genitourinary

Genitourinary complaints have been limited to impotence in approximately 5% of male patients.[Ref]

Endocrine

Endocrinologic abnormalities are due to reserpine-induced hyperprolactinemia. Gynecomastia in men, breast engorgement in women, and pseudolactation have been reported.[Ref]

Immunologic

A 79-year-old woman with hypertension, taking reserpine, potassium, HCTZ, and ibuprofen, developed fatigue, anorexia, fever, night sweats, and weight loss. Associated laboratory findings showed anemia, lymphocytosis, thrombocytopenia, IgA kappa paraproteinemia, positive ANA, and a positive Coombs' test. Bone marrow biopsy, lymphangiography, and lymph node biopsy showed bone marrow lymphocytosis, enlarged foamy abdominal lymph nodes with irregular filling, and angioimmunoblastic lymphadenopathy, respectively. Within four days after discontinuation of reserpine (her other medications were continued), the paraprotein level normalized and the platelet count rose. After an additional nine months of prednisone therapy, all signs and symptoms resolved.[Ref]

Immunologic side effects are rare. One case of angioimmunoblastic lymphadenopathy has been associated with reserpine. In one study of 231 patients, only one case of a lupus-like syndrome was recorded. The patient had previously received hydralazine.[Ref]

Oncologic

Oncologic concerns were raised after a large drug surveillance center in Boston reported an association between reserpine, a stimulator of prolactin, and breast cancer in 1974, which was partially, but not completely, confirmed in two similar centers in Europe. A critical review of the these studies elucidated several design flaws. Subsequent, controlled studies failed to show an association between reserpine and an increased incidence of breast carcinoma.[Ref]

References

1. Pfeifer HJ, Greenblatt DK, Koch-Wester J "Clinical toxicity of reserpine in hospitalized patients: a report from the Boston Collaborative Drug Surveillance Program." Am J Med Sci 271 (1976): 269-76

2. Luxenberg J, Feigenbaum LZ "The use of reserpine for elderly hypertensive patients." J Am Geriatr Soc 31 (1983): 556-9

3. Atuk NO, Owen JA, Jr "Bronchospasm after reserpine." N Engl J Med 281 (1969): 908-9

4. Applegate WB, Carper ER, Kahn SE, Westbrook L, Linton M, Baker MG, Runyan JW, Jr "Comparison of the use of reserpine versus alpha-methyldopa for second step treatment of hypertension in the elderly." J Am Geriatr Soc 33 (1985): 109-15

5. Diamond L "Drug-induced bronchospasm." J Clin Pharmacol J New Drugs 10 (1970): 215-6

6. Kirschenbaum HL, Rosenberg JM "What to look out for with guanethidine and reserpine." RN 47 (1984): 31-3

7. Freis ED "Reserpine in hypertension: present status." Am Fam Physician 11 (1975): 120-2

8. Gibb WE, Malpas JS, Turner P, White RJ "Comparison of bethanidine, alpha-methyldopa, and reserpine in essential hypertension." Lancet 2 (1970): 275-7

9. Segal MS "Bronchospasm after reserpine." N Engl J Med 281 (1969): 1426-7

10. Peters HA "Questioning reserpine's adverse effect on tardive dyskinesia." Am J Psychiatry 140 (1983): 1106

11. Goodwin FK, Bunney WE, Jr "Depressions following reserpine: a reevaluation." Semin Psychiatry 3 (1971): 435-48

12. Bacher NM, Lewis HA "Reserpine and tardive dyskinesia." Am J Psychiatry 141 (1984): 719

13. Berlant JL "Neuroleptics and reserpine in refractory psychoses." J Clin Psychopharmacol 6 (1986): 180-4

14. Murayama M, Yasuda K, Minamori Y, Mercado-Asis LB, Yamakita N, Miura K "Long term follow-up of Cushing's disease treated with reserpine and pituitary irradiation." J Clin Endocrinol Metab 75 (1992): 935-42

15. Donatelli A, Geisen L, Feuer E "Case report of adverse effect of reserpine on tardive dyskinesia." Am J Psychiatry 140 (1983): 239-40

16. Dilsaver SC, Greden JF "Possible cholinergic mechanism in reserpine and tardive dyskinesia." Am J Psychiatry 141 (1984): 151-2

17. Ross RT "Drug-induced parkinsonism and other movement disorders." Can J Neurol Sci 17 (1990): 155-62

18. Reus VI "Behavioral side effects of medical drugs." Prim Care 6 (1979): 283-94

19. Henning M "Adverse reactions to antihypertensive drug therapy: central nervous system." Acta Med Scand Suppl 628 (1979): 33-7

20. Blumenthal M, Davis R, Doe RP "Carcinoid syndrome following reserpine therapy in thyrotoxicosis." Arch Intern Med 116 (1965): 819-23

21. Fleishman M "Letter: Reserpine, ECT, and depression." Am J Psychiatry 132 (1975): 1088

22. Ambrosino SV "Depressive reactions associated with reserpine." N Y State J Med 74 (1974): 860-4

23. Samuels AH, Taylor AJ "Reserpine withdrawal psychosis." Aust N Z J Psychiatry 23 (1989): 129-30

24. Lewis WH "Iatrogenic psychotic depressive reaction in hypertensive patients." Am J Psychiatry 127 (1971): 1416-7

25. Widmer RB "Reserpine: the maligned antihypertensive drug." J Fam Pract 20 (1985): 81-3

26. Kent TA, Wilber RD "Reserpine withdrawal psychosis: the possible role of denervation supersensitivity of receptors." J Nerv Ment Dis 170 (1982): 502-4

27. Sharon E, Paolino JS, Kaplan D "Hematemesis after reserpine for Raynaud's phenomenon." Ann Intern Med 77 (1972): 479-80

28. Dillon PT, Babe J, Meloni CR, Canary JJ "Reserpine in thyrotoxic crisis." N Engl J Med 283 (1970): 1020-3

29. Combs RM "Unusual response to reserpine in paroxysmal atrial tachycardia with block unassociated with digitalis." South Med J 60 (1967): 839-42

30. Entrican JH, Denburg JA, Gauldie J, Kelton JG "Angioimmunoblastic lymphadenopathy associated with reserpine." Lancet 2 (1984): 820-1

31. Newball HH, Byar DP "Does reserpine increase prolactin and exacerbate cancer of prostate? Case control study." Urology 2 (1973): 525-9

32. Curb JD, Hardy RJ, Labarthe DR, Borhani NO, Taylor JO "Reserpine and breast cancer in the Hypertension Detection and Follow- Up Program." Hypertension 4 (1982): 307-11

33. Mack TM, Henderson BE, Gerkins VR, et al "Reserpine and breast cancer in a retirement community." N Engl J Med 292 (1975): 1366-71

34. Kodlin D, McCarthy N "Reserpine and breast cancer." Cancer 41 (1978): 761-8

35. Jick H "Editorial: Reserpine and breast cancer: a perspective." JAMA 233 (1975): 896-7

36. Labarthe DR, O'Fallon WM "Reserpine and breast cancer. A community-based longitudinal study of 2,000 hypertensive women." JAMA 243 (1980): 2304-10

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