Reserpine, Hydralazine, and Hydrochlorothiazide (Systemic)

Brand Names : Cam-Ap-Es, Cherapas, Ser-A-Gen, Seralazide, Ser-Ap-Es, Serpazide, Tri-Hydroserpine, Unipres

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 reserpine, hydralazine, and hydrochlorothiazide, the following should be considered:

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

Pregnancy - Too much use of reserpine and hydrochlorothiazide during pregnancy may cause unwanted effects (jaundice, blood problems, low potassium, difficult breathing, low temperatures, and loss of appetite) in the baby. In rats, rauwolfia alkaloids (like reserpine) decrease newborn survival rates.

Studies with hydralazine have not been done in humans. However, studies in mice have shown that hydralazine causes birth defects (cleft palate, defects in head and face bones); these birth defects may also occur in rabbits, but do not occur in rats. Be sure that you have discussed this with your doctor before taking this medicine.

Breast-feeding - Reserpine passes into breast milk and may cause unwanted effects (difficult breathing, low temperature, loss of appetite) in infants of mothers taking large doses of it. Hydrochlorothiazide also passes 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 this medicine in children with use in other age groups, this medicine is not expected to cause different side effects or problems in children than it does 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 reserpine, hydralazine, and hydrochlorothiazide combination 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 usually more sensitive to the effects of this medicine. Also, this medicine may reduce tolerance to cold temperatures in elderly patients.

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 this medicine, 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

• Diazoxide (e.g., Proglycem) - Effect on blood pressure may be increased

• Digitalis glycosides (heart medicine) - Hydrochlorothiazide 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 this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

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

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

• Epilepsy

• Gallstones or
• Stomach ulcer or
• Ulcerative colitis - Reserpine increases activity of the stomach, which may make the condition worse

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

• Heart disease - Reserpine can cause heart rhythm problems or slow heartbeat. Lowering blood pressure may worsen some conditions

• Kidney disease - Some patients may not do well when blood pressure is lowered by this medicine. Effects of hydralazine may be increased because of slower removal from the body. If kidney disease is severe, hydrochlorothiazide may not work

• Liver disease - If hydrochlorothiazide causes loss of too much water from the body, liver disease can become much worse

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

• Mental depression (or history of) - Reserpine causes mental depression

• Pancreatitis (inflammation of pancreas)

• Parkinson's disease - Reserpine can cause parkinsonism-like effects

• Pheochromocytoma

• Stroke (recent) - Lowering blood pressure may make problems resulting from this condition worse