Editing Reserpine (section)

{{Short description|Drug used to treat high blood pressure}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Distinguish|Reserpidine|Risperidone}}
{{Infobox drug
| Watchedfields         = changed
| verifiedrevid         = 460779417
| IUPAC_name            = methyl (3β,16β,17α,18β,20α)-11,17-dimethoxy-18-[(3,4,5-trimethoxybenzoyl)oxy]yohimban-16-carboxylate and
| image                 = [[File:Reserpine.svg|frameless|reserpine 2D skeletal]]
| width                 = 320
| image2                = [[File:Reserpine structure.png|frameless|reserpine 3D BS]]
| width2                 = 320

<!--Clinical data-->
| tradename             = Serpasil, others
| Drugs.com             = {{drugs.com|CDI|reserpine}}
| MedlinePlus           = a601107
| licence_US            = Reserpine
| pregnancy_category    = C
| legal_status          = Rx-only (banned/discontinued in some countries)
| routes_of_administration                        = Oral

<!--Pharmacokinetic data-->
| bioavailability       = 50%
| metabolism            = gut/liver
| elimination_half-life = phase 1 = 4.5h,<br /> phase 2 = 271h, <br /> average = 33h
| excretion             = 62% feces / 8% urine

<!--Identifiers-->
| IUPHAR_ligand         = 4823
| CAS_number_Ref        = {{cascite|correct|??}}
| CAS_number            = 50-55-5
| ATC_prefix            = C02
| ATC_suffix            = AA02
| PubChem               = 5770
| DrugBank_Ref          = {{drugbankcite|correct|drugbank}}
| DrugBank              = DB00206
| ChemSpiderID_Ref      = {{chemspidercite|correct|chemspider}}
| ChemSpiderID          = 5566
| UNII_Ref              = {{fdacite|correct|FDA}}
| UNII                  = 8B1QWR724A
| KEGG_Ref              = {{keggcite|correct|kegg}}
| KEGG                  = D00197
| ChEBI_Ref             = {{ebicite|correct|EBI}}
| ChEBI                 = 28487
| ChEMBL_Ref            = {{ebicite|correct|EBI}}
| ChEMBL                = 772

<!--Chemical data-->
| C                     = 33 | H=40 | N=2 | O=9
| smiles                = [H][C@]26C[C@@H](OC(=O)c1cc(OC)c(OC)c(OC)c1)[C@H](OC)[C@@H](C(=O)OC)[C@@]2([H])C[C@]5([H])c4[nH]c3cc(OC)ccc3c4CCN5C6
| StdInChI_Ref          = {{stdinchicite|correct|chemspider}}
| StdInChI              = 1S/C33H40N2O9/c1-38-19-7-8-20-21-9-10-35-16-18-13-27(44-32(36)17-11-25(39-2)30(41-4)26(12-17)40-3)31(42-5)28(33(37)43-6)22(18)15-24(35)29(21)34-23(20)14-19/h7-8,11-12,14,18,22,24,27-28,31,34H,9-10,13,15-16H2,1-6H3/t18-,22+,24-,27-,28+,31+/m1/s1
| StdInChIKey_Ref       = {{stdinchicite|correct|chemspider}}
| StdInChIKey           = QEVHRUUCFGRFIF-MDEJGZGSSA-N
}}
'''Reserpine''' is a drug that is used for the treatment of [[hypertension|high blood pressure]], usually in combination with a [[thiazide]] diuretic or vasodilator.<ref>{{cite journal | vauthors = Tsioufis C, Thomopoulos C | title = Combination drug treatment in hypertension | journal = Pharmacological Research | volume = 125 | issue = Pt B | pages = 266–271 | date = November 2017 | pmid = 28939201 | doi = 10.1016/j.phrs.2017.09.011 | s2cid = 32904492 }}</ref> Large clinical trials have shown that combined treatment with reserpine plus a thiazide diuretic reduces mortality of people with hypertension. Although the use of reserpine as a solo drug has declined since it was first approved by the FDA in 1955,<ref>{{Cite web|url=http://drugcentral.org/drugcard/2370|title=Reserpine}}</ref> the combined use of reserpine and a thiazide diuretic or vasodilator is still recommended in patients who do not achieve adequate lowering of blood pressure with first-line drug treatment alone.<ref>{{cite journal | vauthors = James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC, Svetkey LP, Taler SJ, Townsend RR, Wright JT, Narva AS, Ortiz E | title = 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8) | journal = JAMA | volume = 311 | issue = 5 | pages = 507–20 | date = February 2014 | pmid = 24352797 | doi = 10.1001/jama.2013.284427 | doi-access =  }}</ref><ref>{{cite journal | vauthors = Weir MR | title = Reserpine: A New Consideration of and Old Drug for Refractory Hypertension | journal = American Journal of Hypertension | volume = 33 | issue = 8 | pages = 708–710 | date = August 2020 | pmid = 32303749 | pmc = 7402223 | doi = 10.1093/ajh/hpaa069 }}</ref><ref>{{cite journal | vauthors = Barzilay J, Grimm R, Cushman W, Bertoni AG, Basile J | title = Getting to goal blood pressure: why reserpine deserves a second look | journal = Journal of Clinical Hypertension | volume = 9 | issue = 8 | pages = 591–4 | date = August 2007 | pmid = 17673879 | doi = 10.1111/j.1524-6175.2007.07229.x | pmc = 8110058 | doi-access = free }}</ref> The reserpine-[[hydrochlorothiazide]] combo pill was the 17th most commonly prescribed of the 43 combination antihypertensive pills available in 2012.<ref>{{cite journal | vauthors = Wang B, Choudhry NK, Gagne JJ, Landon J, Kesselheim AS | title = Availability and utilization of cardiovascular fixed-dose combination drugs in the United States | journal = American Heart Journal | volume = 169 | issue = 3 | pages = 379–386.e1 | date = March 2015 | pmid = 25728728 | doi = 10.1016/j.ahj.2014.12.014 }}</ref>

The antihypertensive actions of reserpine are largely due to its antinoradrenergic effects, which are a result of its ability to deplete [[catecholamine]]s (among other [[monoamine neurotransmitters]]) from [[peripheral nervous system|peripheral]] [[sympathetic nervous system|sympathetic]] nerve endings. These substances are normally involved in controlling heart rate, force of cardiac contraction and peripheral vascular resistance.<ref name="veterinary1">Forney, Barbara. [http://www.wedgewoodpharmacy.com/monographs/reserpine.asp Reserpine for Veterinary Use] Wedgewood Pharmacy. 2001-2002.</ref>

At doses of 0.05 to 0.2&nbsp;mg per day, reserpine is well tolerated;<ref>{{cite journal | vauthors = Morley JE | title = Treatment of hypertension in older persons: what is the evidence? | journal = Drugs & Aging | volume = 31 | issue = 5 | pages = 331–7 | date = May 2014 | pmid = 24668034 | doi = 10.1007/s40266-014-0171-7 | s2cid = 207489850 }}</ref> the most common adverse effect being nasal stuffiness.

Reserpine has also been used for relief of [[psychotic]] symptoms.<ref>{{cite journal | vauthors = Hoenders HJ, Bartels-Velthuis AA, Vollbehr NK, Bruggeman R, Knegtering H, de Jong JT | title = Natural Medicines for Psychotic Disorders: A Systematic Review | journal = The Journal of Nervous and Mental Disease | volume = 206 | issue = 2 | pages = 81–101 | date = February 2018 | pmid = 29373456 | pmc = 5794244 | doi = 10.1097/NMD.0000000000000782 }}</ref> A review found that in persons with schizophrenia, reserpine and chlorpromazine had similar rates of adverse effects, but that reserpine was less effective than [[chlorpromazine]] for improving a person's global state.<ref>{{cite journal | vauthors = Nur S, Adams CE | title = Chlorpromazine versus reserpine for schizophrenia | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD012122 | date = April 2016 | issue = 4 | pmid = 27124109 | doi = 10.1002/14651858.CD012122.pub2 | pmc = 10350329 }}</ref>