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Reserpine Uses, Dosage, Side Effects & Warnings | DrugsAtlas

Authoritative Clinical Reference

DRUG NAME: Reserpine

Therapeutic Class: Antihypertensive

Subclass: Rauwolfia alkaloid (Centrally acting sympatholytic)

Speciality: Cardiology

Schedule (India): Schedule H

Route(s): Oral

Formulations Available in India:

• Reserpine tablet: 0.1 mg
• Reserpine tablet: 0.25 mg
• Fixed-dose combinations with hydrochlorothiazide (various strengths)
• Fixed-dose combinations with hydralazine and hydrochlorothiazide

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

1. Hypertension — Chronic Management (usually as combination therapy)

Parameter	Recommendation
Starting dose	0.05–0.1 mg once daily
Titration	Increase by 0.05–0.1 mg every 1–2 weeks based on BP response
Usual maintenance dose	0.1–0.25 mg once daily
Maximum dose	0.25 mg once daily (higher doses significantly increase CNS adverse effects)

Clinical Notes:
→ Antihypertensive effect is gradual — onset may take 1–3 weeks; avoid rapid dose escalation
→ Most effective when combined with thiazide diuretic — synergistic BP reduction
→ Not recommended as first-line monotherapy — consider only when modern agents unavailable, unaffordable, or in resistant hypertension
→ Once-daily dosing due to prolonged duration of action (irreversible monoamine depletion)
→ Screen for depression history before initiating therapy

Secondary Indications – Adults (Off-label, if any)

• Not applicable — no established off-label uses in current Indian practice

PAEDIATRIC DOSING (Specialist Only)

Primary Indications (Approved / Standard in India)

• NOT RECOMMENDED for paediatric use in India
• High risk of CNS toxicity (depression, sedation) and cardiovascular adverse effects in children
• No validated paediatric dosing established

Secondary Indications – Paediatric doses (Off-label, if any)

• Not applicable

Clear Statement: Use in patients below 18 years is not recommended except under specialist supervision in rare cases of refractory hypertension where all other options have failed.

RENAL ADJUSTMENT

Renal Function	Recommendation
Mild to moderate impairment (eGFR ≥30 mL/min)	No dose adjustment required
Severe impairment (eGFR <30 mL/min)	Use with caution — increased risk of hypotensive episodes
End-stage renal disease / Dialysis	Avoid unless under specialist supervision; hypotension risk significant

HEPATIC ADJUSTMENT

Severity (Child-Pugh)	Recommendation
Class A (Mild)	No dose adjustment required
Class B (Moderate)	Use with caution; initiate at 0.05 mg daily; slower titration
Class C (Severe)	Avoid — impaired hepatic metabolism increases drug accumulation and CNS toxicity risk

CONTRAINDICATIONS

• History of major depressive disorder or current depression
• Active peptic ulcer disease or history of peptic ulcer
• Ulcerative colitis
• Phaeochromocytoma
• Electroconvulsive therapy (planned or recent)
• Known hypersensitivity to reserpine or other Rauwolfia alkaloids
• Symptomatic bradycardia or sick sinus syndrome
• Concurrent MAO inhibitor therapy

CAUTIONS

• History of any mental illness including anxiety disorders — risk of precipitating depression
• Parkinson’s disease — may worsen extrapyramidal symptoms due to dopamine depletion
• Bronchial asthma or chronic obstructive pulmonary disease — may increase bronchial secretions
• Gallstone disease — increases gallbladder motility
• Renal artery stenosis
• Elderly patients — enhanced sensitivity to CNS and cardiovascular effects
• Patients on multiple antihypertensives — additive hypotension
• Avoid abrupt discontinuation — risk of rebound hypertension

PREGNANCY

Parameter	Guidance
Overall safety	Avoid during pregnancy unless no safer alternative available
Risks	May cause neonatal respiratory depression, nasal congestion, bradycardia, hypothermia, and lethargy
Preferred alternatives	Labetalol, methyldopa, nifedipine (as per Indian obstetric practice)
When permissible	Only if potential benefit justifies fetal risk; specialist obstetric input required
Monitoring	Maternal BP and mental status; fetal heart rate; neonatal observation post-delivery

LACTATION

Parameter	Guidance
Breastfeeding compatibility	Use with caution; small amounts excreted in breast milk
Milk levels	Low
Preferred alternatives	Methyldopa, labetalol, nifedipine
Infant monitoring	Observe for sedation, nasal congestion, poor feeding, reduced weight gain

ELDERLY

• Starting dose: 0.05 mg once daily
• Titration: Very slow — increase at intervals of 2–4 weeks only if necessary
• Increased risks:

Depression and cognitive impairment
Orthostatic hypotension leading to falls
Excessive sedation
Bradycardia
Parkinsonism
• Avoid in patients with pre-existing cognitive impairment or polypharmacy
• Regular mental status assessment recommended

MAJOR DRUG INTERACTIONS

Interacting Drug	Effect	Management
MAO inhibitors (phenelzine, tranylcypromine, selegiline)	Risk of hypertensive crisis due to release of stored catecholamines; also paradoxical severe hypotension	CONTRAINDICATED — avoid concurrent use
Levodopa / Carbidopa-Levodopa	Reserpine depletes central dopamine stores → antagonises antiparkinsonian effect	AVOID combination
Tricyclic antidepressants (amitriptyline, imipramine)	Antagonism of antihypertensive effect; also may worsen depression	Avoid if possible; monitor BP and mood
Digitalis glycosides (digoxin)	Additive bradycardia and AV conduction delay	Avoid combination or monitor ECG closely

MODERATE DRUG INTERACTIONS

Interacting Drug	Effect	Management
Beta-blockers	Additive bradycardia and hypotension	Commonly used combination; monitor heart rate and BP
Thiazide/loop diuretics	Enhanced hypotension; hypokalaemia may worsen cardiac effects	Monitor BP and electrolytes
Other CNS depressants (benzodiazepines, opioids, antihistamines)	Additive sedation	Use with caution; warn about drowsiness
Antidiabetic agents (sulfonylureas, insulin)	Potential enhanced hypoglycaemic effect	Monitor blood glucose
Alcohol	Enhanced CNS depression and hypotension	Advise avoidance
Quinidine	Additive cardiac depression	Monitor ECG

COMMON ADVERSE EFFECTS

• Nasal congestion (due to vasodilatation)
• Sedation and drowsiness
• Depression and mood changes
• Bradycardia
• Orthostatic hypotension
• Dizziness
• Diarrhoea or increased bowel motility
• Dry mouth
• Weight gain
• Sexual dysfunction (impotence, decreased libido)

SERIOUS ADVERSE EFFECTS

• Severe depression with suicidal ideation — requires immediate discontinuation and psychiatric referral
• Parkinsonism and extrapyramidal symptoms — may persist weeks after discontinuation
• Peptic ulcer activation, perforation, or gastrointestinal bleeding — discontinue immediately
• Severe bradycardia or heart block
• Syncope due to profound hypotension
• Bronchospasm or asthma exacerbation
• Gynaecomastia (rare, with prolonged use)

MONITORING REQUIREMENTS

Baseline:
• Blood pressure and heart rate
• Mental health screening (depression history, current mood status)
• ECG (especially in elderly or those with cardiac history)
• Renal and hepatic function tests

After Initiation/Dose Change:
• BP and heart rate at 1–2 week intervals
• Mental status assessment — specifically screen for mood changes, anhedonia, sleep disturbance during first 4–6 weeks
• GI symptoms (epigastric pain, dark stools)

Long-term:
• Blood pressure monitoring at regular intervals
• Annual mental health evaluation
• Periodic assessment for extrapyramidal symptoms
• GI symptom review

BRANDS AVAILABLE IN INDIA

Single-ingredient:
• Serpasil (legacy brand — limited availability)

Fixed-Dose Combinations:
• Adelphane (reserpine + dihydralazine + hydrochlorothiazide)
• Adelphane-Esidrex (reserpine + dihydralazine + hydrochlorothiazide)
• Various generic FDCs with hydrochlorothiazide

Note: Single-ingredient reserpine tablets have limited market availability; FDCs more commonly stocked

PRICE RANGE (INR)

• Reserpine tablet 0.1 mg: ₹1–2 per tablet
• Reserpine tablet 0.25 mg: ₹2–4 per tablet
• FDC tablets: ₹2–10 per tablet (depending on combination and brand)
• NLEM status: Not included in NLEM 2022
• Government supply: Limited availability

CLINICAL PEARLS

• Rarely indicated as monotherapy — always consider modern first-line agents (ACE inhibitors, ARBs, CCBs, thiazides) before reserpine
• May be considered in resource-limited settings or resistant hypertension as add-on therapy due to very low cost
• Screen thoroughly for depression history — even subclinical depression is a relative contraindication
• CNS effects (depression, sedation) are dose-dependent — keep dose ≤0.25 mg/day
• Effects persist for weeks after discontinuation due to irreversible depletion of catecholamine stores
• Nasal congestion is often the earliest adverse effect — useful early warning sign of excessive dosing

Clinical Responsibility

This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.

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