Rauwolfia Alkaloids and Thiazide Diuretics (Systemic)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For rauwolfia alkaloids and thiazide diuretics, the following should be considered:

Allergies - Tell your doctor if you have ever had any unusual or allergic reaction to sulfonamides (sulfa drugs), thiazide diuretics (water pills), or rauwolfia alkaloids. Also tell your health care professional if you are allergic to any other substance, such as foods, preservatives, or dyes.

Pregnancy - Too much use of thiazide diuretics (contained in this combination medicine) during pregnancy may cause unwanted effects including jaundice, blood problems, and low potassium in the baby. Too much use of rauwolfia alkaloids may cause difficult breathing, low temperature, and loss of appetite in the baby. This medicine has not been shown to cause birth defects in humans. In rats, use of rauwolfia alkaloids during pregnancy decreases newborn survival rates. Be sure that you have discussed this with your doctor before taking this medicine.

Breast-feeding - Rauwolfia alkaloids pass into breast milk and may cause unwanted effects (difficult breathing, low temperature, loss of appetite) in infants of mothers taking it in large doses. Thiazide diuretics also pass into breast milk. Be sure you have discussed this with your doctor before taking this medicine.

Children - Although there is no specific information comparing use of these medicines in children with use in other age groups, these medicines are not expected to cause different side effects or problems in children than they do in adults.

Older adults - Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults. Although there is no specific information comparing use of rauwolfia alkaloid and thiazide diuretic combinations in the elderly with use in other age groups, this medicine is not expected to cause different side effects or problems in older people than it does in younger adults. However, drowsiness, dizziness, or faintness or symptoms of too much potassium loss may be more likely to occur in the elderly, who are more sensitive to the effects of rauwolfia alkaloids and thiazide diuretics.

Other medicines - Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking rauwolfia alkaloids and thiazide diuretics, it is especially important that your health care professional know if you are taking any of the following:

• Cholestyramine or
• Colestipol - Use with thiazide diuretics may prevent the diuretic from working properly; take the diuretic at least 1 hour before or 4 hours after cholestyramine or colestipol

• Digitalis glycosides (heart medicine) - Thiazide diuretics may cause low potassium in the blood, which can lead to symptoms of digitalis toxicity

• Lithium (e.g., Lithane) - Risk of lithium overdose, even at usual doses, may be increased

• Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate]) - Taking a rauwolfia alkaloid while you are taking or within 2 weeks of taking MAO inhibitors may increase the risk of central nervous system depression or may cause a severe high blood pressure reaction

Other medical problems - The presence of other medical problems may affect the use of rauwolfia alkaloids and thiazide diuretics. Make sure you tell your doctor if you have any other medical problems, especially:

• Allergies or other breathing problems such as asthma - Rauwolfia alkaloids can cause breathing problems

• Diabetes mellitus (sugar diabetes) - Thiazide diuretics may change the amount of diabetes medicine needed

• Epilepsy

• Gallstones or
• Stomach ulcer or
• Ulcerative colitis - Rauwolfia alkaloids increase activity of the stomach, which may make the condition worse

• Gout (history of) - Thiazide diuretics may increase the amount of uric acid in the blood, which can lead to gout

• Heart disease - Rauwolfia alkaloids can cause heart rhythm problems or slow heartbeat

• Kidney disease - Some patients may not do well when blood pressure is lowered by this medicine. If kidney disease is severe, thiazide diuretics may not work

• Liver disease - If thiazide diuretics cause loss of too much water from the body, liver disease can become much worse

• Lupus erythematosus (history of) - Thiazide diuretics may worsen the condition

• Mental depression (or history of) - Rauwolfia alkaloids cause mental depression

• Pancreatitis (inflammation of pancreas)

• Parkinson's disease - Rauwolfia alkaloids can cause parkinsonism-like effects

• Pheochromocytoma