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  • CLASSES

    Rauwolfia Alkaloids

    DEA CLASS

    Rx

    DESCRIPTION

    Oral rauwolfia alkaloid antihypertensive; now less commonly used for HTN; may be used in combination with a thiazide diuretic for HTN or to treat psychotic disorders; safer and more effective alternatives are usually available; associated with hypotension, sedation, and impotence.

    HOW SUPPLIED

    Reserpine Oral Tab: 0.1mg, 0.25mg

    DOSAGE & INDICATIONS

    For the treatment of hypertension.
    Oral dosage
    Adults

    Due to the potential for adverse effects at the higher starting doses recommended by the manufacturer (0.5 mg PO once daily), it is prudent to initiate with lower doses of 0.05 mg to 0.1 mg PO once daily, then carefully titrate. Usual dose range: 0.1 mg to 0.25 mg PO once daily. When given with a diuretic, the initial dose is 0.05 mg PO once daily; titrate up to 0.125 mg PO once daily if needed for BP control. Use the lowest possible dose to limit adverse effects.

    Geriatric Adults

    Due to the potential for adverse effects at the higher starting doses recommended by the manufacturer (0.5 mg PO once daily), it is prudent to initiate therapy with lower doses of 0.05 mg to 0.1 mg PO once daily, then carefully titrate. Usual adult dose range: 0.1 mg to 0.25 mg PO once daily. When given in combination with a diuretic, the initial dose is 0.05 mg PO once daily; titrate up to 0.125 mg PO once daily if needed for BP control. Use the lowest possible dose to minimize adverse effects.[51016] According to the Beers Criteria, reserpine is a potentially inappropriate medication (PIM) in geriatric patients; avoid as a routine treatment of hypertension in doses more than 0.1 mg/day due to the high risk of adverse CNS effects and the possibility of bradycardia or orthostatic hypotension.[63923]

    MAXIMUM DOSAGE

    Adults

    0.5 mg/day PO for hypertension; 1.0 mg/day PO for psychotic disorders.

    Elderly

    0.25 mg/day PO.

    Adolescents

    Use alternative agents in adolescents to avoid CNS depressant side effects.

    Children

    Use alternative agents in children to avoid CNS depressant side effects.

    DOSING CONSIDERATIONS

    Hepatic Impairment

    No specific dosage guidelines are available. Dosage reduction may be warranted for patients with hepatic impairment; reserpine is extensively metabolized in the liver. Initiate dosage cautiously; adjust dosage based on clinical response.

    Renal Impairment

    CrCl < 10 ml/min: avoid use of reserpine.
     
    Intermittent hemodialysis
    Avoid use of reserpine.

    ADMINISTRATION

    Oral Administration

    Monitor blood pressure frequently during initiation of therapy.

    STORAGE

    Generic:
    - Protect from moisture
    - Store at room temperature (between 59 to 86 degrees F)

    CONTRAINDICATIONS / PRECAUTIONS

    Rauwolfia alkaloid hypersensitivity, salicylate hypersensitivity, tartrazine dye hypersensitivity

    Reserpine should not be used in patients with a history of rauwolfia alkaloid hypersensitivity. Rauwolfia alkaloids include deserpidine, rauwolfia serpentina, or yohimbine. Patients sensitive to these agents may also be sensitive to reserpine. Certain preparations of reserpine (e.g., Naquival, Metatensin #2, Raudixin 50 and 100 mg, and Rauzide) contain tartrazine dye and can cause allergic responses and are contraindicated in patients with a history of tartrazine dye hypersensitivity. Although the incidence of this dye hypersensitivity is low, it can be serious. Because FD&C yellow No. 5 (tartrazine) dye sensitivity may occur in patients with salicylate hypersensitivity, reserpine products containing tartrazine should be used cautiously in this population. Allergic-type reactions, including bronchial asthmatic events, may occur in certain susceptible individuals.

    Cholelithiasis, peptic ulcer disease, ulcerative colitis

    Reserpine can increase gastric acid secretion and increase gastric motility. Reserpine is contraindicated in active peptic ulcer disease or ulcerative colitis as reserpine can exacerbate these conditions. Patients who have a history of these disease states should be treated with caution. Reserpine also should be used cautiously in patients with a history of cholelithiasis because biliary colic could occur.

    Hepatic disease

    No information is available regarding the use of reserpine in patients with hepatic disease. Dosage reduction may be warranted for patients with significant hepatic impairment; reserpine is extensively metabolized in the liver.

    Cardiac arrhythmias, cardiac disease, pheochromocytoma

    Reserpine should be used with caution in patients with cardiac disease such as cardiac arrhythmias or pheochromocytoma. Reserpine has been reported to cause arrhythmias and bradycardia.

    Geriatric

    Geriatric patients may be more sensitive to the usual adult dosage and are at increased risk for adverse effects of reserpine (e.g., sedation, hypotension). According to the Beers Criteria, reserpine is considered a potentially inappropriate medication (PIM) in geriatric patients; avoid routine use of this drug for hypertension, especially in doses of more than 0.1 mg/day, due to the high risk of adverse CNS effects and the possibility of bradycardia or orthostatic hypotension.[63923] The federal Omnibus Budget Reconciliation Act (OBRA) regulates medication use in residents of long-term care facilities (LTCFs). According to OBRA, antihypertensive regimens should be individualized to achieve the desired outcome while minimizing adverse effects. Antihypertensives may cause dizziness, postural hypotension, fatigue, and there is an increased risk for falls. There are many drug interactions that can potentiate the effects of antihypertensives. Some agents require a gradual taper to avoid adverse consequences caused by abrupt discontinuation.[60742]

    Electroconvulsive therapy (ECT)

    Reserpine is contraindicated in patients receiving electroconvulsive therapy (ECT) because depletion of catecholamines can increase the risk of convulsions. It is recommended that following reserpine therapy, at least 1 week should elapse before electroconvulsive therapy is initiated.

    Depression, Parkinson's disease, seizure disorder, suicidal ideation

    Reserpine should not be used in patients with a seizure disorder and is contraindicated in patients with a history of major depression, especially those who have suicidal ideation. Reserpine can cause decreased mental function, and patients should be warned of the hazards of operating heavy machinery or driving an automobile while receiving reserpine. Depression can be aggravated by reserpine therapy. Also, reserpine should be used with caution in patients with Parkinson's disease.

    Renal disease

    Avoid using reserpine in patients who have advanced renal disease, renal failure, or severe renal impairment (CrCl < 10 ml/min) due its potential for long-lasting antihypertensive effects and the potential adverse effects of hypotension on the kidney.

    Pregnancy

    Reserpine is not recommended for use during pregnancy and is considered to most closely correspond to an FDA pregnancy risk category D (manufacturer lists as FDA pregnancy risk category C). Animal reproduction studies have suggested adverse fetal effects. Reserpine administered parenterally has been shown to be teratogenic in rats at doses up to 2 mg/kg and to have an embryocidal effect in guinea pigs given dosages of 0.5 mg daily. Reserpine crosses the placental barrier, and increased respiratory tract secretions, nasal congestion, cyanosis, and anorexia may occur in neonates of reserpine-treated human mothers.

    Breast-feeding

    According to the manufacturer, reserpine should not be used in breast-feeding women. Reserpine is excreted into breast milk in significant amounts to cause increased respiratory tract secretions, nasal congestion, cyanosis, and anorexia in breast-feeding infants. Because of the potential for adverse reactions in nursing infants and the potential for tumorigenicity shown for reserpine in animal studies, a decision should be made whether to discontinue nursing or to discontinue the drug. An alternative agent for blood pressure treatment is preferred. The American Academy of Pediatrics (AAP) has not evaluated the use of reserpine in breast-feeding mothers. The AAP regards alternative agents, such as enalapril, hydrochlorothiazide, methyldopa, nifedipine, and propranolol as usually compatible with breast-feeding. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.

    MAOI therapy

    Administration of reserpine to patients receiving MAOI therapy can cause hypertension and increased excitation. Avoid co-therapy whenever possible (see Drug Interactions).

    Children, infants

    Safety and effectiveness in children have not been established by means of controlled clinical trials, although there is some clinical experience with the use of reserpine in children. Because of adverse effects such as emotional depression and lability, sedation, and stuffy nose, reserpine is not usually recommended as a step-2 drug in the treatment of hypertension in children. There is no known indication for the drug in infants or neonates.

    Diabetes mellitus

    Reserpine may mask the signs and symptoms of hypoglycemia. When used in patients with diabetes mellitus, monitor for changes in glycemic control.

    ADVERSE REACTIONS

    Severe

    heart failure / Delayed / Incidence not known
    uveitis / Delayed / Incidence not known
    hearing loss / Delayed / Incidence not known
    optic atrophy / Delayed / Incidence not known
    arrhythmia exacerbation / Early / Incidence not known
    bradycardia / Rapid / Incidence not known

    Moderate

    depression / Delayed / Incidence not known
    pseudoparkinsonism / Delayed / Incidence not known
    dyspnea / Early / Incidence not known
    conjunctivitis / Delayed / Incidence not known
    hypotension / Rapid / Incidence not known
    impotence (erectile dysfunction) / Delayed / Incidence not known
    ejaculation dysfunction / Delayed / Incidence not known
    dysuria / Early / Incidence not known
    hyperprolactinemia / Delayed / Incidence not known

    Mild

    dizziness / Early / Incidence not known
    drowsiness / Early / Incidence not known
    nightmares / Early / Incidence not known
    headache / Early / Incidence not known
    anxiety / Delayed / Incidence not known
    miosis / Early / Incidence not known
    syncope / Early / Incidence not known
    weight gain / Delayed / Incidence not known
    nausea / Early / Incidence not known
    anorexia / Delayed / Incidence not known
    xerostomia / Early / Incidence not known
    vomiting / Early / Incidence not known
    diarrhea / Early / Incidence not known
    breast enlargement / Delayed / Incidence not known
    libido decrease / Delayed / Incidence not known
    gynecomastia / Delayed / Incidence not known
    rash / Early / Incidence not known
    purpura / Delayed / Incidence not known
    pruritus / Rapid / Incidence not known
    epistaxis / Delayed / Incidence not known
    nasal congestion / Early / Incidence not known
    musculoskeletal pain / Early / Incidence not known

    DRUG INTERACTIONS

    Acarbose: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Acebutolol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Acetaminophen; Chlorpheniramine; Phenylephrine : (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Acetaminophen; Dextromethorphan; Guaifenesin; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Acetaminophen; Dextromethorphan; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Acetaminophen; Dextromethorphan; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Acetaminophen; Dichloralphenazone; Isometheptene: (Major) Sympathomimetics can antagonize the antihypertensive effects of adrenergic agonists when administered concomitantly. Patients should be monitored for loss of blood pressure control.
    Acetaminophen; Guaifenesin; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Acetaminophen; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Acetazolamide: (Moderate) The concomitant administration of reserpine with diuretics or other antihypertensive agents can result in additive hypotensive effects. This interaction may be desirable, but dosages should be adjusted accordingly.
    Acetohexamide: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Acrivastine; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Albiglutide: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents, such as incretin mimetics, should be monitored for changes in glycemic control.
    Aldesleukin, IL-2: (Moderate) Reserpine may potentiate the hypotension seen with aldesleukin, IL 2.
    Alemtuzumab: (Moderate) Alemtuzumab may cause hypotension. Careful monitoring of blood pressure and hypotensive symptoms is recommended especially in patients with ischemic heart disease and in patients on antihypertensive agents.
    Alogliptin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Alogliptin; Metformin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control.
    Alogliptin; Pioglitazone: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Alpha-glucosidase Inhibitors: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Alprostadil: (Minor) The concomitant use of systemic alprostadil injection and antihypertensive agents, such as reserpine, may cause additive hypotension. Caution is advised with this combination. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. In those men with significant corpora cavernosa venous leakage, hypotension might be more likely. Use caution with in-clinic dosing for erectile dysfunction (ED) and monitor for the effects on blood pressure. In addition, the presence of medications in the circulation that attenuate erectile function may influence the response to alprostadil. However, in clinical trials with alprostadil intracavernous injection, anti-hypertensive agents had no apparent effect on the safety and efficacy of alprostadil.
    Amifostine: (Major) Patients receiving reserpine should be closely monitored during amifostine infusions due to additive effects. Patients receiving amifostine at doses recommended for chemotherapy should have antihypertensive therapy interrupted 24 hours preceding administration of amifostine. If the antihypertensive cannot be stopped, patients should not receive amifostine.
    Amitriptyline: (Major) Reserpine may have decreased antihypertensive effects in the presence of tricyclic antidepressants, and a stimulating effect has been noted in depressed patients taking reserpine along with a TCA. Avoid use of TCAs concurrently with these antihypertensive drug categories when possible.
    Amlodipine; Celecoxib: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Amobarbital: (Moderate) Administration of reserpine can potentiate the depressant effects of CNS depressants such as barbiturates.
    Amoxapine: (Major) Reserpine may have decreased antihypertensive effects in the presence of amoxapine. Avoid use of amoxapine concurrently with reserpine when possible.
    Amphetamine; Dextroamphetamine Salts: (Major) Concurrent use of amphetamines and gastrointestinal acidifying agents, such as reserpine, lowers the absorption of amphetamines, reducing their efficacy. In addition, amphetamines increase both systolic and diastolic blood pressure and may counteract the activity of some agents for blood pressure such as reserpine. Close monitoring of blood pressure or the selection of alternative therapeutic agents may be needed.
    Amyl Nitrite: (Moderate) Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Dosage adjustments may be necessary.
    Apomorphine: (Moderate) Coadministration of antihypertensives and apomorphine can increase the hypotensive effects of apomorphine. Monitor blood pressure regularly during concomitant use of reserpine and apomorphine.
    Apraclonidine: (Minor) Alpha blockers as a class may reduce heart rate and blood pressure. While no specific drug interactions have been identified with systemic agents and apraclonidine during clinical trials, it is theoretically possible that additive blood pressure reductions could occur when apraclonidine is combined with the use of antihypertensive agents. Patients using cardiovascular drugs concomitantly with apraclonidine should have their pulse and blood pressure monitored periodically.
    Aripiprazole: (Minor) Aripiprazole may enhance the hypotensive effects of antihypertensive agents.
    Articaine; Epinephrine: (Major) Reserpine can increase the tissue sensitivity to epinephrine leading to severe hypertension and arrhythmias. Reserpine causes increased receptor sensitivity secondary to depletion of either norepinephrine or epinephrine from adrenergic nerve endings. Epinephrine should be used cautiously in patients receiving reserpine.
    Asenapine: (Moderate) Secondary to alpha-blockade, asenapine can produce vasodilation that may result in additive effects during concurrent use of antihypertensive agents. The potential reduction in blood pressure can precipitate orthostatic hypotension and associated dizziness, tachycardia, and syncope. If concurrent use of asenapine and antihypertensive agents is necessary, patients should be counseled on measures to prevent orthostatic hypotension, such as sitting on the edge of the bed for several minutes prior to standing in the morning and rising slowly from a seated position. Close monitoring of blood pressure is recommended until the full effects of the combination therapy are known.
    Aspirin, ASA; Butalbital; Caffeine: (Moderate) Administration of reserpine can potentiate the depressant effects of CNS depressants such as barbiturates.
    Aspirin, ASA; Butalbital; Caffeine; Codeine: (Moderate) Administration of reserpine can potentiate the depressant effects of CNS depressants such as barbiturates.
    Atenolol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Atenolol; Chlorthalidone: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Baclofen: (Moderate) Baclofen has been associated with hypotension. Concurrent use with baclofen and antihypertensive agents may result in additive hypotension. Dosage adjustments of the antihypertensive medication may be required.
    Barbiturates: (Moderate) Administration of reserpine can potentiate the depressant effects of CNS depressants such as barbiturates.
    Belladonna Alkaloids; Ergotamine; Phenobarbital: (Moderate) Administration of reserpine can potentiate the depressant effects of CNS depressants such as barbiturates.
    Bendroflumethiazide; Nadolol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Benzphetamine: (Major) Concurrent use of amphetamines and gastrointestinal acidifying agents, such as reserpine, lowers the absorption of amphetamines, reducing their efficacy. In addition, amphetamines increase both systolic and diastolic blood pressure and may counteract the activity of some agents for blood pressure such as reserpine. Close monitoring of blood pressure or the selection of alternative therapeutic agents may be needed.
    Beta-adrenergic blockers: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Betaxolol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Bisoprolol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Bisoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Bortezomib: (Moderate) Patients on antihypertensive agents receiving bortezomib treatment may require close monitoring of their blood pressure and dosage adjustment of their medication. During clinical trials of bortezomib, hypotension was reported in roughly 12 percent of patients.
    Brimonidine; Timolol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Brompheniramine; Carbetapentane; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Brompheniramine; Dextromethorphan; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Brompheniramine; Hydrocodone; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Brompheniramine; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Brompheniramine; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Brompheniramine; Pseudoephedrine; Dextromethorphan: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Bupivacaine; Epinephrine: (Major) Reserpine can increase the tissue sensitivity to epinephrine leading to severe hypertension and arrhythmias. Reserpine causes increased receptor sensitivity secondary to depletion of either norepinephrine or epinephrine from adrenergic nerve endings. Epinephrine should be used cautiously in patients receiving reserpine.
    Bupivacaine; Meloxicam: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Butabarbital: (Moderate) Administration of reserpine can potentiate the depressant effects of CNS depressants such as barbiturates.
    Butalbital; Acetaminophen: (Moderate) Administration of reserpine can potentiate the depressant effects of CNS depressants such as barbiturates.
    Butalbital; Acetaminophen; Caffeine: (Moderate) Administration of reserpine can potentiate the depressant effects of CNS depressants such as barbiturates.
    Butalbital; Acetaminophen; Caffeine; Codeine: (Moderate) Administration of reserpine can potentiate the depressant effects of CNS depressants such as barbiturates.
    Cabergoline: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including reserpine. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. In addition, the prolactin-lowering effect of cabergoline may be diminished by medications that increase prolactin levels such as reserpine. Monitor for decreased response to cabergoline.
    Canagliflozin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Canagliflozin; Metformin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control.
    Carbetapentane; Chlorpheniramine; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Carbetapentane; Diphenhydramine; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Carbetapentane; Guaifenesin; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Carbetapentane; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Carbetapentane; Phenylephrine; Pyrilamine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Carbetapentane; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Carbidopa; Levodopa: (Contraindicated) Concomitant use of antihypertensive agents with levodopa can result in additive hypotensive effects. Rauwolfia alkaloids, such as reserpine, deplete dopamine stores in the brain, thereby antagonizing the effects of levodopa.
    Carbidopa; Levodopa; Entacapone: (Contraindicated) Concomitant use of antihypertensive agents with levodopa can result in additive hypotensive effects. Rauwolfia alkaloids, such as reserpine, deplete dopamine stores in the brain, thereby antagonizing the effects of levodopa.
    Carbinoxamine; Dextromethorphan; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Carbinoxamine; Hydrocodone; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Carbinoxamine; Hydrocodone; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Carbinoxamine; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Carbinoxamine; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Carbonic anhydrase inhibitors: (Moderate) The concomitant administration of reserpine with diuretics or other antihypertensive agents can result in additive hypotensive effects. This interaction may be desirable, but dosages should be adjusted accordingly.
    Cardiac glycosides: (Moderate) Concomitant administration of reserpine and cardiac glycosides can increase the risk of developing arrhythmias, especially when large doses of reserpine are used.
    Cariprazine: (Moderate) Orthostatic vital signs should be monitored in patients who are at risk for hypotension, such as those receiving cariprazine in combination with antihypertensive agents. Atypical antipsychotics may cause orthostatic hypotension and syncope, most commonly during treatment initiation and dosage increases. Patients should be informed about measures to prevent orthostatic hypotension, such as sitting on the edge of the bed for several minutes prior to standing in the morning, or rising slowly from a seated position. Consider a cariprazine dose reduction if hypotension occurs.
    Carteolol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Carvedilol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Celecoxib: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Celecoxib; Tramadol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Cetirizine; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Chlophedianol; Dexchlorpheniramine; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Chlophedianol; Guaifenesin; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Chlordiazepoxide; Amitriptyline: (Major) Reserpine may have decreased antihypertensive effects in the presence of tricyclic antidepressants, and a stimulating effect has been noted in depressed patients taking reserpine along with a TCA. Avoid use of TCAs concurrently with these antihypertensive drug categories when possible.
    Chloroprocaine: (Moderate) Local anesthetics may cause additive hypotension in combination with antihypertensive agents.
    Chlorpheniramine; Dextromethorphan; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Chlorpheniramine; Dihydrocodeine; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Chlorpheniramine; Dihydrocodeine; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Chlorpheniramine; Hydrocodone; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Chlorpheniramine; Hydrocodone; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved. (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Chlorpheniramine; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Chlorpheniramine; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Chlorpropamide: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Clomipramine: (Major) Reserpine may have decreased antihypertensive effects in the presence of tricyclic antidepressants, and a stimulating effect has been noted in depressed patients taking reserpine along with a TCA. Avoid use of TCAs concurrently with these antihypertensive drug categories when possible.
    Clozapine: (Moderate) Clozapine used concomitantly with the antihypertensive agents can increase the risk and severity of hypotension by potentiating the effect of the antihypertensive drug.
    Cocaine: (Major) Use of cocaine with antihypertensive agents may increase the antihypertensive effects of the antihypertensive medications or may potentiate cocaine-induced sympathetic stimulation.
    Codeine; Guaifenesin; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Codeine; Phenylephrine; Promethazine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Co-Enzyme Q10, Ubiquinone: (Moderate) Co-enzyme Q10, ubiquinone (CoQ10) may lower blood pressure. CoQ10 use in combination with antihypertensive agents may lead to additional reductions in blood pressure in some individuals. Patients who choose to take CoQ10 concurrently with antihypertensive medications should receive periodic blood pressure monitoring. Patients should be advised to inform their prescriber of their use of CoQ10.
    Dapagliflozin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Dapagliflozin; Metformin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control.
    Dapagliflozin; Saxagliptin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia because of their sympatholytic activity. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Degarelix: (Major) Avoid coadministration of degarelix with reserpine due to the risk of reduced efficacy of degarelix. Reserpine can cause hyperprolactinemia, which reduces the number of pituitary gonadotropin releasing hormone (GnRH) receptors; degarelix is a GnRH analog.
    Desipramine: (Major) Reserpine may have decreased antihypertensive effects in the presence of tricyclic antidepressants, and a stimulating effect has been noted in depressed patients taking reserpine along with a TCA. Avoid use of TCAs concurrently with these antihypertensive drug categories when possible.
    Desloratadine; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Desogestrel; Ethinyl Estradiol: (Minor) Estrogen-containing oral contraceptive may induce fluid retention and may increase blood pressure in some patients taking antihypertensive agents. Such patients should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Deutetrabenazine: (Contraindicated) Concurrent use of deutetrabenazine and reserpine is contraindicated. At least 20 days should elapse after stopping reserpine before initiating treatment with deutetrabenazine; wait for chorea or dyskinesia to reemerge before administering deutetrabenazine to reduce the risk of overdosage and major depletion of serotonin and norepinephrine in the CNS. Reserpine binds irreversibly to vesicular monoamine transporter 2 (VMAT2), and the duration of its effect is several days. Deutetrabenazine is a selective, reversible, monoamine depleting drug that works by inhibiting VMAT2.
    Dexbrompheniramine; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Dextromethorphan; Diphenhydramine; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Dextromethorphan; Guaifenesin; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Dextromethorphan; Guaifenesin; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Dextromethorphan; Quinidine: (Moderate) Reserpine-induced arrhythmias are more likely to occur during concomitant administration of quinidine. Quinidine can decrease blood pressure and should be used cautiously in patients receiving antihypertensive agents due to the potential for additive hypotension.
    Diazoxide: (Moderate) Marked hypotensive episodes can result from concomitant administration of diazoxide and reserpine. Reserpine should not be administered within 6 hours of administration of IV diazoxide.
    Diclofenac: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Diclofenac; Misoprostol: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Diethylpropion: (Major) Sympathomimetics can increase both systolic and diastolic blood pressure and may counteract the activity of reserpine. This represents a pharmacodynamic, and not a pharmacokinetic, interaction.
    Diflunisal: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Dihydrocodeine; Guaifenesin; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Diphenhydramine; Hydrocodone; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Diphenhydramine; Ibuprofen: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Diphenhydramine; Naproxen: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Diphenhydramine; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Dobutamine: (Major) Sympathomimetics can increase both systolic and diastolic blood pressure and may counteract the activity of reserpine. This represents a pharmacodynamic, and not a pharmacokinetic, interaction.
    Dopamine: (Major) Concomitant use of reserpine with direct-acting sympathomimetics can potentiate the vasopressor effects of the sympathomimetic and antagonize the antihypertensive effects of reserpine.
    Dorzolamide; Timolol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Doxepin: (Major) Reserpine may have decreased antihypertensive effects in the presence of tricyclic antidepressants, and a stimulating effect has been noted in depressed patients taking reserpine along with a TCA. Avoid use of TCAs concurrently with these antihypertensive drug categories when possible.
    Drospirenone; Ethinyl Estradiol: (Minor) Estrogen-containing oral contraceptive may induce fluid retention and may increase blood pressure in some patients taking antihypertensive agents. Such patients should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Drospirenone; Ethinyl Estradiol; Levomefolate: (Minor) Estrogen-containing oral contraceptive may induce fluid retention and may increase blood pressure in some patients taking antihypertensive agents. Such patients should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Dulaglutide: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents, such as incretin mimetics, should be monitored for changes in glycemic control.
    Duloxetine: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. The concurrent administration of antihypertensive agents and duloxetine may increase the risk of hypotension. It is advisable to monitor blood pressure if the combination is necessary.
    Eletriptan: (Major) Eletriptan may reduce the effectiveness of antihypertensive agents. Increased blood pressure may be an adverse effect of eletriptan, and the drug is contraindicated for use in patients with uncontrolled hypertension.
    Empagliflozin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Empagliflozin; Linagliptin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents, such as linagliptin, should be monitored for changes in glycemic control.
    Empagliflozin; Linagliptin; Metformin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents, such as linagliptin, should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control.
    Empagliflozin; Metformin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control.
    Enflurane: (Moderate) General anesthetics can potentiate the hypotensive effects of antihypertensive agents.
    Ephedrine: (Moderate) Carefully monitor blood pressure in patients who have received both ephedrine and reserpine; reserpine antagonizes the pressor effect of ephedrine.
    Ephedrine; Guaifenesin: (Moderate) Carefully monitor blood pressure in patients who have received both ephedrine and reserpine; reserpine antagonizes the pressor effect of ephedrine.
    Epinephrine: (Major) Reserpine can increase the tissue sensitivity to epinephrine leading to severe hypertension and arrhythmias. Reserpine causes increased receptor sensitivity secondary to depletion of either norepinephrine or epinephrine from adrenergic nerve endings. Epinephrine should be used cautiously in patients receiving reserpine.
    Epoprostenol: (Moderate) Epoprostenol can have additive effects when administered with other antihypertensive agents. These effects can be used to therapeutic advantage, but dosage adjustments may be necessary.
    Ertugliflozin; Metformin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control.
    Ertugliflozin; Sitagliptin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia because of their sympatholytic activity. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Esmolol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Estradiol Cypionate; Medroxyprogesterone: (Minor) Estrogens can induce fluid retention and may increase blood pressure in some patients; patients who are receiving antihypertensive agents concurrently with hormonal contraceptives should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Estradiol: (Minor) Estrogens can induce fluid retention and may increase blood pressure in some patients; patients who are receiving antihypertensive agents concurrently with hormonal contraceptives should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Ethinyl Estradiol: (Minor) Estrogen-containing oral contraceptive may induce fluid retention and may increase blood pressure in some patients taking antihypertensive agents. Such patients should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate: (Minor) Estrogen-containing oral contraceptive may induce fluid retention and may increase blood pressure in some patients taking antihypertensive agents. Such patients should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Ethinyl Estradiol; Norelgestromin: (Minor) Estrogen-containing oral contraceptive may induce fluid retention and may increase blood pressure in some patients taking antihypertensive agents. Such patients should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Ethinyl Estradiol; Norethindrone Acetate: (Minor) Estrogen-containing oral contraceptive may induce fluid retention and may increase blood pressure in some patients taking antihypertensive agents. Such patients should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Ethinyl Estradiol; Norgestrel: (Minor) Estrogen-containing oral contraceptive may induce fluid retention and may increase blood pressure in some patients taking antihypertensive agents. Such patients should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Ethynodiol Diacetate; Ethinyl Estradiol: (Minor) Estrogen-containing oral contraceptive may induce fluid retention and may increase blood pressure in some patients taking antihypertensive agents. Such patients should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Etodolac: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Etomidate: (Moderate) General anesthetics can potentiate the hypotensive effects of antihypertensive agents.
    Etonogestrel; Ethinyl Estradiol: (Minor) Estrogen-containing oral contraceptive may induce fluid retention and may increase blood pressure in some patients taking antihypertensive agents. Such patients should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Exenatide: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents, such as incretin mimetics, should be monitored for changes in glycemic control.
    Fenoprofen: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Fexofenadine; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Fish Oil, Omega-3 Fatty Acids (Dietary Supplements): (Moderate) High doses of fish oil supplements may produce a blood pressure lowering effect. It is possible that additive reductions in blood pressure may be seen when fish oils are used in a patient already taking antihypertensive agents.
    Flurbiprofen: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Fospropofol: (Moderate) General anesthetics can potentiate the hypotensive effects of antihypertensive agents.
    General anesthetics: (Moderate) General anesthetics can potentiate the hypotensive effects of antihypertensive agents.
    Glimepiride: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Glimepiride; Rosiglitazone: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Glipizide: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Glipizide; Metformin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control.
    Glyburide: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Glyburide; Metformin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control.
    Goserelin: (Major) Avoid coadministration of goserelin with reserpine due to the risk of reduced efficacy of goserelin. Reserpine can cause hyperprolactinemia, which reduces the number of pituitary gonadotropin releasing hormone (GnRH) receptors; goserelin is a GnRH analog.
    Guaifenesin; Hydrocodone; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Guaifenesin; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Guaifenesin; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Haloperidol: (Moderate) In general, haloperidol should be used cautiously with antihypertensive agents due to the possibility of additive hypotension.
    Halothane: (Moderate) General anesthetics can potentiate the hypotensive effects of antihypertensive agents.
    Histrelin: (Major) Avoid coadministration of histrelin with reserpine due to the risk of reduced efficacy of histrelin. Reserpine can cause hyperprolactinemia, which reduces the number of pituitary gonadotropin releasing hormone (GnRH) receptors; histrelin is a GnRH analog.
    Hydralazine; Isosorbide Dinitrate, ISDN: (Moderate) Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Dosage adjustments may be necessary.
    Hydrocodone; Ibuprofen: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Hydrocodone; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Hydrocodone; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Ibuprofen: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Ibuprofen; Famotidine: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Ibuprofen; Oxycodone: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Ibuprofen; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved. (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Iloperidone: (Moderate) Secondary to alpha-blockade, iloperidone can produce vasodilation that may result in additive effects during concurrent use with antihypertensive agents. The potential reduction in blood pressure can precipitate orthostatic hypotension and associated dizziness, tachycardia, and syncope. If concurrent use of iloperidone and antihypertensive agents is necessary, patients should be counseled on measures to prevent orthostatic hypotension, such as sitting on the edge of the bed for several minutes prior to standing in the morning and rising slowly from a seated position. Close monitoring of blood pressure is recommended until the full effects of the combination therapy are known.
    Iloprost: (Moderate) Further reductions in blood pressure may occur when inhaled iloprost is administered to patients receiving other antihypertensive agents.
    Imipramine: (Major) Reserpine may have decreased antihypertensive effects in the presence of tricyclic antidepressants, and a stimulating effect has been noted in depressed patients taking reserpine along with a TCA. Avoid use of TCAs concurrently with these antihypertensive drug categories when possible.
    Incretin Mimetics: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents, such as incretin mimetics, should be monitored for changes in glycemic control.
    Indomethacin: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Insulin Degludec; Liraglutide: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents, such as incretin mimetics, should be monitored for changes in glycemic control.
    Insulin Glargine; Lixisenatide: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents, such as incretin mimetics, should be monitored for changes in glycemic control.
    Insulins: (Moderate) Monitor patients receiving insulin closely for changes in glycemic control during the use of reserpine. Reserpine may mask the signs and symptoms of hypoglycemia.
    Intravenous Lipid Emulsions: (Moderate) High doses of fish oil supplements may produce a blood pressure lowering effect. It is possible that additive reductions in blood pressure may be seen when fish oils are used in a patient already taking antihypertensive agents.
    Iobenguane I 131: (Major) Discontinue reserpine for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart reserpine until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as reserpine, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
    Isocarboxazid: (Contraindicated) The concomitant use of reserpine and monoamine oxidase inhibitors (MAOIs) is contraindicated. Acutely, reserpine can increase the risk of hypertensive crisis by causing an initial release of catecholamines from bound stores. During chronic administration, additive CNS depressant effects and hypotension are possible.
    Isoflurane: (Moderate) General anesthetics can potentiate the hypotensive effects of antihypertensive agents.
    Isoproterenol: (Major) Sympathomimetics can increase both systolic and diastolic blood pressure and may counteract the activity of reserpine. This represents a pharmacodynamic, and not a pharmacokinetic, interaction.
    Isosorbide Dinitrate, ISDN: (Moderate) Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Dosage adjustments may be necessary.
    Isosorbide Mononitrate: (Moderate) Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Dosage adjustments may be necessary.
    Ketamine: (Moderate) General anesthetics can potentiate the hypotensive effects of antihypertensive agents.
    Ketoprofen: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Ketorolac: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Labetalol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Lansoprazole; Naproxen: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Leuprolide: (Major) Avoid coadministration of leuprolide with reserpine due to the risk of reduced efficacy of leuprolide. Reserpine can cause hyperprolactinemia, which reduces the number of pituitary gonadotropin releasing hormone (GnRH) receptors; leuprolide is a GnRH analog.
    Leuprolide; Norethindrone: (Major) Avoid coadministration of leuprolide with reserpine due to the risk of reduced efficacy of leuprolide. Reserpine can cause hyperprolactinemia, which reduces the number of pituitary gonadotropin releasing hormone (GnRH) receptors; leuprolide is a GnRH analog.
    Levobetaxolol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Levobunolol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Levodopa: (Contraindicated) Concomitant use of antihypertensive agents with levodopa can result in additive hypotensive effects. Rauwolfia alkaloids, such as reserpine, deplete dopamine stores in the brain, thereby antagonizing the effects of levodopa.
    Levonorgestrel; Ethinyl Estradiol: (Minor) Estrogen-containing oral contraceptive may induce fluid retention and may increase blood pressure in some patients taking antihypertensive agents. Such patients should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate: (Minor) Estrogen-containing oral contraceptive may induce fluid retention and may increase blood pressure in some patients taking antihypertensive agents. Such patients should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Lidocaine; Epinephrine: (Major) Reserpine can increase the tissue sensitivity to epinephrine leading to severe hypertension and arrhythmias. Reserpine causes increased receptor sensitivity secondary to depletion of either norepinephrine or epinephrine from adrenergic nerve endings. Epinephrine should be used cautiously in patients receiving reserpine.
    Linagliptin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents, such as linagliptin, should be monitored for changes in glycemic control.
    Linagliptin; Metformin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents, such as linagliptin, should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control.
    Linezolid: (Moderate) Concomitant use of linezolid and reserpine can cause hypertension and increased excitation. Closely monitor for increased blood pressure during coadministration. Linezolid is an antibiotic that is also a weak, reversible nonselective inhibitor of monoamine oxidase (MAO). Reserpine depletes intracellular catecholamines by initially causing their release from bound stores, so the acute administration of reserpine to patients currently taking an MAOI can lead to hypertensive crisis.
    Liraglutide: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents, such as incretin mimetics, should be monitored for changes in glycemic control.
    Lisdexamfetamine: (Major) Concurrent use of amphetamines and gastrointestinal acidifying agents, such as reserpine, lowers the absorption of amphetamines, reducing their efficacy. In addition, amphetamines increase both systolic and diastolic blood pressure and may counteract the activity of some agents for blood pressure such as reserpine. Close monitoring of blood pressure or the selection of alternative therapeutic agents may be needed.
    Lixisenatide: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents, such as incretin mimetics, should be monitored for changes in glycemic control.
    Loratadine; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Lovastatin; Niacin: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise.
    Lurasidone: (Moderate) Due to the antagonism of lurasidone at alpha-1 adrenergic receptors, the drug may enhance the hypotensive effects of alpha-blockers and other antihypertensive agents. If concurrent use of lurasidone and antihypertensive agents is necessary, patients should be counseled on measures to prevent orthostatic hypotension, such as sitting on the edge of the bed for several minutes prior to standing in the morning and rising slowly from a seated position. Close monitoring of blood pressure is recommended until the full effects of the combination therapy are known.
    Maprotiline: (Major) Reserpine may have decreased antihypertensive effects in the presence of cyclic antidepressants, and a stimulating effect has been noted in depressed patients taking reserpine along with a TCA. Avoid use of maprotiline concurrently with reserpine when possible.
    Mecamylamine: (Moderate) The concomitant administration of reserpine with diuretics or other antihypertensive agents can result in additive hypotensive effects. This interaction may be desirable, but dosages should be adjusted accordingly.
    Meclofenamate Sodium: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Mefenamic Acid: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Meglitinides: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control.
    Meloxicam: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Mephobarbital: (Moderate) Administration of reserpine can potentiate the depressant effects of CNS depressants such as barbiturates.
    Mestranol; Norethindrone: (Minor) Estrogen containing oral contraceptives can induce fluid retention and may increase blood pressure in some patients; monitor patients receiving concurrent therapy to confirm that the desired antihypertensive effect is being obtained.
    Metformin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control.
    Metformin; Repaglinide: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control.
    Metformin; Rosiglitazone: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Metformin; Saxagliptin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia because of their sympatholytic activity. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control.
    Metformin; Sitagliptin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia because of their sympatholytic activity. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control.
    Methamphetamine: (Minor) Amphetamines increase both systolic and diastolic blood pressure and may counteract the activity of some antihypertensive agents, like reserpine. Close monitoring of blood pressure is advised.
    Methazolamide: (Moderate) The concomitant administration of reserpine with diuretics or other antihypertensive agents can result in additive hypotensive effects. This interaction may be desirable, but dosages should be adjusted accordingly.
    Methohexital: (Moderate) Administration of reserpine can potentiate the depressant effects of CNS depressants such as barbiturates.
    Methylphenidate Derivatives: (Major) Coadministration of methylphenidate derivatives and reserpine should be avoided if possible. Methylphenidate derivatives and reserpine may interact pharmacodynamically to diminish the therapeutic effects of either agent through opposing effects on neurotransmitters. Methylphenidate blocks the reuptake of norepinephrine and dopamine into the presynaptic neuron and increases the release of these monoamines into the extraneuronal space while reserpine depletes stores of serotonin and norepinephrine in the brain, adrenal medulla, and other tissues, and reduces the reuptake of catecholamines by adrenergic nerve terminals. Reserpine binds tightly to catecholamine storage vesicles in the adrenergic neuron, eventually destroying these vesicles so that the terminals cannot concentrate or store norepinephrine or dopamine. This process also occurs in vesicles that store serotonin.
    Metoprolol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Metoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Midodrine: (Major) Sympathomimetics can increase both systolic and diastolic blood pressure and may counteract the activity of reserpine. This represents a pharmacodynamic, and not a pharmacokinetic, interaction.
    Miglitol: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Milrinone: (Moderate) Concurrent administration of antihypertensive agents could lead to additive hypotension when administered with milrinone. Titrate milrinone dosage according to hemodynamic response.
    Monoamine oxidase inhibitors: (Contraindicated) The concomitant use of reserpine and monoamine oxidase inhibitors (MAOIs) is contraindicated. Acutely, reserpine can increase the risk of hypertensive crisis by causing an initial release of catecholamines from bound stores. During chronic administration, additive CNS depressant effects and hypotension are possible.
    Nabumetone: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Nadolol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Naproxen: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Naproxen; Esomeprazole: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Naproxen; Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved. (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Nateglinide: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control.
    Nebivolol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Nebivolol; Valsartan: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Nefazodone: (Minor) Although relatively infrequent, nefazodone may cause orthostatic hypotension in some patients; this effect may be additive with antihypertensive agents. Blood pressure monitoring and dosage adjustments of either drug may be necessary.
    Nesiritide, BNP: (Major) The potential for hypotension may be increased when coadministering nesiritide with antihypertensive agents.
    Niacin, Niacinamide: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise.
    Niacin; Simvastatin: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise.
    Nitrates: (Moderate) Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Dosage adjustments may be necessary.
    Nitroglycerin: (Moderate) Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Dosage adjustments may be necessary.
    Nitroprusside: (Moderate) Additive hypotensive effects may occur when nitroprusside is used concomitantly with other antihypertensive agents. Dosages should be adjusted carefully, according to blood pressure.
    Nonsteroidal antiinflammatory drugs: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Norethindrone Acetate; Ethinyl Estradiol; Ferrous fumarate: (Minor) Estrogen-containing oral contraceptive may induce fluid retention and may increase blood pressure in some patients taking antihypertensive agents. Such patients should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Norethindrone; Ethinyl Estradiol: (Minor) Estrogen-containing oral contraceptive may induce fluid retention and may increase blood pressure in some patients taking antihypertensive agents. Such patients should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Norethindrone; Ethinyl Estradiol; Ferrous fumarate: (Minor) Estrogen-containing oral contraceptive may induce fluid retention and may increase blood pressure in some patients taking antihypertensive agents. Such patients should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Norgestimate; Ethinyl Estradiol: (Minor) Estrogen-containing oral contraceptive may induce fluid retention and may increase blood pressure in some patients taking antihypertensive agents. Such patients should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Nortriptyline: (Major) Reserpine may have decreased antihypertensive effects in the presence of tricyclic antidepressants, and a stimulating effect has been noted in depressed patients taking reserpine along with a TCA. Avoid use of TCAs concurrently with these antihypertensive drug categories when possible.
    Olanzapine: (Moderate) Olanzapine may induce orthostatic hypotension and thus enhance the effects of antihypertensive agents.
    Olanzapine; Fluoxetine: (Moderate) Olanzapine may induce orthostatic hypotension and thus enhance the effects of antihypertensive agents.
    Olanzapine; Samidorphan: (Moderate) Olanzapine may induce orthostatic hypotension and thus enhance the effects of antihypertensive agents.
    Oxaprozin: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Oxymetazoline: (Major) The vasoconstricting actions of oxymetazoline, an alpha adrenergic agonist, may reduce the antihypertensive effects produced by reserpine. If these drugs are used together, closely monitor for changes in blood pressure.
    Paliperidone: (Moderate) Paliperidone may cause orthostatic hypotension, thereby enhancing the hypotensive effects of antihypertensive agents. Orthostatic vital signs should be monitored in patients receiving paliperidone and reserpine who are susceptible to hypotension.
    Penbutolol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Pentobarbital: (Moderate) Administration of reserpine can potentiate the depressant effects of CNS depressants such as barbiturates.
    Pentoxifylline: (Moderate) Pentoxifylline has been used concurrently with antihypertensive drugs (beta blockers, diuretics) without observed problems. Small decreases in blood pressure have been observed in some patients treated with pentoxifylline; periodic systemic blood pressure monitoring is recommended for patients receiving concomitant antihypertensives. If indicated, dosage of the antihypertensive agents should be reduced.
    Perphenazine; Amitriptyline: (Major) Reserpine may have decreased antihypertensive effects in the presence of tricyclic antidepressants, and a stimulating effect has been noted in depressed patients taking reserpine along with a TCA. Avoid use of TCAs concurrently with these antihypertensive drug categories when possible.
    Phendimetrazine: (Major) Sympathomimetics can increase both systolic and diastolic blood pressure and may counteract the activity of reserpine. This represents a pharmacodynamic, and not a pharmacokinetic, interaction.
    Phenelzine: (Contraindicated) The concomitant use of reserpine and monoamine oxidase inhibitors (MAOIs) is contraindicated. Acutely, reserpine can increase the risk of hypertensive crisis by causing an initial release of catecholamines from bound stores. During chronic administration, additive CNS depressant effects and hypotension are possible.
    Phenobarbital: (Moderate) Administration of reserpine can potentiate the depressant effects of CNS depressants such as barbiturates.
    Phenobarbital; Hyoscyamine; Atropine; Scopolamine: (Moderate) Administration of reserpine can potentiate the depressant effects of CNS depressants such as barbiturates.
    Phentermine: (Major) Phentermine has vasopressor effects and may limit the benefit of antihypertensive agents particularly sympatholytic agents such as reserpine. Concomitant use of phentermine with reserpine may antagonize the antihypertensive effects of these agents. Although leading drug interaction texts differ in the potential for an interaction between phentermine and this group of antihypertensive agents, these effects are likely to be clinically significant and have been described in hypertensive patients on these medications.
    Phentermine; Topiramate: (Major) Phentermine has vasopressor effects and may limit the benefit of antihypertensive agents particularly sympatholytic agents such as reserpine. Concomitant use of phentermine with reserpine may antagonize the antihypertensive effects of these agents. Although leading drug interaction texts differ in the potential for an interaction between phentermine and this group of antihypertensive agents, these effects are likely to be clinically significant and have been described in hypertensive patients on these medications.
    Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Pindolol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Pioglitazone: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Pioglitazone; Glimepiride: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Pioglitazone; Metformin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control. (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Piroxicam: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Pramlintide: (Moderate) Because of its sympatholytic activity, reserpine may mask the signs and symptoms of hypoglycemia.
    Prazosin: (Moderate) Prazosin is well-known to produce a 'first-dose' phenomenon. Some patients develop significant hypotension shortly after administration of the first dose. The first dose response (acute postural hypotension) of prazosin may be exaggerated in patients who are receiving beta-adrenergic blockers, diuretics, or other antihypertensive agents. Concomitant administration of prazosin with other antihypertensive agents is not prohibited, however. This can be therapeutically advantageous, but lower dosages of each agent should be used.
    Prilocaine; Epinephrine: (Major) Reserpine can increase the tissue sensitivity to epinephrine leading to severe hypertension and arrhythmias. Reserpine causes increased receptor sensitivity secondary to depletion of either norepinephrine or epinephrine from adrenergic nerve endings. Epinephrine should be used cautiously in patients receiving reserpine.
    Primidone: (Moderate) Administration of reserpine can potentiate the depressant effects of CNS depressants such as barbiturates.
    Procainamide: (Moderate) Procainamide can decrease blood pressure and should be used cautiously in patients receiving antihypertensive agents. Intravenous administration of procainamide is more likely to cause hypotensive effects.
    Procaine: (Moderate) Local anesthetics may cause additive hypotension in combination with antihypertensive agents. Use extreme caution with the concomitant use of procaine and antihypertensive agents. Peripheral vasodilation may occur after use of procaine.
    Procarbazine: (Contraindicated) Administration of reserpine to patients receiving monoamine oxidase inhibitors (MAOIs), such as procarbazine, can cause hypertension and increased excitation. These effects presumably are due to the sudden increases in catecholamine levels. Administration of MAOIs to patients receiving reserpine can potentiate the adverse CNS depressant effects.
    Promethazine; Phenylephrine: (Major) The cardiovascular effects of sympathomimetics, such as phenylephrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Propofol: (Moderate) General anesthetics can potentiate the hypotensive effects of antihypertensive agents.
    Propranolol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Propranolol; Hydrochlorothiazide, HCTZ: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Protriptyline: (Major) Reserpine may have decreased antihypertensive effects in the presence of tricyclic antidepressants, and a stimulating effect has been noted in depressed patients taking reserpine along with a TCA. Avoid use of TCAs concurrently with these antihypertensive drug categories when possible.
    Pseudoephedrine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Pseudoephedrine; Triprolidine: (Major) The cardiovascular effects of sympathomimetics, such as pseudoephedrine, may reduce the antihypertensive effects produced by reserpine. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved.
    Quinidine: (Moderate) Reserpine-induced arrhythmias are more likely to occur during concomitant administration of quinidine. Quinidine can decrease blood pressure and should be used cautiously in patients receiving antihypertensive agents due to the potential for additive hypotension.
    Rasagiline: (Moderate) Administration of reserpine to patients receiving monoamine oxidase inhibitors (MAOIs) can cause hypertension and increased excitation. These effects presumably are due to the sudden increases in catecholamine levels. Administration of MAOIs to patients receiving reserpine can potentiate the adverse CNS depressant effects. Rasagiline is a selective MAO-B inhibitor at manufacturer recommended doses; therefore, serious reactions with antihypertensive agents affecting catecholamines are expected to be less likely to occur with rasagiline.
    Repaglinide: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly should be monitored for changes in glycemic control.
    Risperidone: (Moderate) Risperidone may induce orthostatic hypotension and thus enhance the hypotensive effects of antihypertensive agents. Lower initial doses or slower dose titration of risperidone may be necessary in patients receiving antihypertensive agents concomitantly.
    Ritodrine: (Major) Sympathomimetics can increase both systolic and diastolic blood pressure and may counteract the activity of reserpine. This represents a pharmacodynamic, and not a pharmacokinetic, interaction.
    Rofecoxib: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Rosiglitazone: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Saxagliptin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia because of their sympatholytic activity. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Secobarbital: (Moderate) Administration of reserpine can potentiate the depressant effects of CNS depressants such as barbiturates.
    Segesterone Acetate; Ethinyl Estradiol: (Minor) Estrogen-containing oral contraceptive may induce fluid retention and may increase blood pressure in some patients taking antihypertensive agents. Such patients should be monitored to confirm that the desired antihypertensive effect is being obtained.
    Selegiline: (Moderate) Closely monitor for increased blood pressure during concomitant use of selegiline and reserpine. Coadministration can cause hypertension and increased excitation. Reserpine depletes intracellular catecholamines by initially causing their release from bound stores, so the acute administration of reserpine to patients currently taking an MAOI can lead to hypertensive crisis.
    Semaglutide: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents, such as incretin mimetics, should be monitored for changes in glycemic control.
    Sevoflurane: (Moderate) General anesthetics can potentiate the hypotensive effects of antihypertensive agents.
    Silodosin: (Moderate) During clinical trials with silodosin, the incidence of dizziness and orthostatic hypotension was higher in patients receiving concomitant antihypertensive treatment. Thus, caution is advisable when silodosin is administered with antihypertensive agents.
    Simvastatin; Sitagliptin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia because of their sympatholytic activity. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Sitagliptin: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia because of their sympatholytic activity. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Sotalol: (Major) Use caution when adminstering sotalol together with catecholamine-depleting agents, such as reserpine or other rauwolfia alkaloids, as concomitant use may cause excessive reductions in resting sympathetic tone can produce hypotension or bradycardia, precipitating a syncopal episode.
    Sulfonylureas: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Sulindac: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Sumatriptan; Naproxen: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Tetrabenazine: (Contraindicated) Reserpine binds irreversibly to vesicular monoamine transporter 2 (VMAT2) and the duration of its effect on serotonin and norepinephrine in the CNS is several days. Tetrabenazine is a selective, reversible, centrally-acting dopamine depleting drug that works by inhibiting vesicular monoamine transporter 2 (VMAT2). Therefore, concurrently use of tetrabenazine and reserpine is contraindicated. At least 20 days should elapse after stopping reserpine before initiating treatment with tetrabenazine.
    Tetracaine: (Moderate) Local anesthetics may cause additive hypotension in combination with antihypertensive agents. Use extreme caution with the concomitant use of tetracaine and antihypertensive agents.
    Thalidomide: (Major) Avoid the concomitant use of thalidomide with other central nervous system depressants such as reserpine due to the potential for additive sedative effects.
    Thiazolidinediones: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving these drugs concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Thiopental: (Moderate) Administration of reserpine can potentiate the depressant effects of CNS depressants such as barbiturates.
    Thiothixene: (Moderate) Thiothixene should be used cautiously in patients receiving antihypertensive agents. Additive hypotensive effects are possible.
    Timolol: (Moderate) Reserpine may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion. Beta-blockers may also interfere with reflex tachycardia, worsening the orthostasis. Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension).
    Tirzepatide: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents, such as incretin mimetics, should be monitored for changes in glycemic control.
    Tizanidine: (Moderate) Concurrent use of tizanidine with antihypertensive agents can result in significant hypotension. Caution is advised when tizanidine is to be used in patients receiving concurrent antihypertensive therapy.
    Tolazamide: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Tolbutamide: (Moderate) Reserpine may mask the signs and symptoms of hypoglycemia. Patients receiving reserpine concomitantly with antidiabetic agents should be monitored for changes in glycemic control.
    Tolmetin: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Tranylcypromine: (Contraindicated) The concomitant use of reserpine and monoamine oxidase inhibitors (MAOIs) is contraindicated. Acutely, reserpine can increase the risk of hypertensive crisis by causing an initial release of catecholamines from bound stores. During chronic administration, additive CNS depressant effects and hypotension are possible.
    Trazodone: (Minor) Due to additive hypotensive effects, patients receiving antihypertensive agents concurrently with trazodone may have excessive hypotension. Decreased dosage of the antihypertensive agent may be required when given with trazodone.
    Tricyclic antidepressants: (Major) Reserpine may have decreased antihypertensive effects in the presence of tricyclic antidepressants, and a stimulating effect has been noted in depressed patients taking reserpine along with a TCA. Avoid use of TCAs concurrently with these antihypertensive drug categories when possible.
    Trimipramine: (Major) Reserpine may have decreased antihypertensive effects in the presence of tricyclic antidepressants, and a stimulating effect has been noted in depressed patients taking reserpine along with a TCA. Avoid use of TCAs concurrently with these antihypertensive drug categories when possible.
    Triptorelin: (Major) Avoid coadministration of triptorelin with reserpine due to the risk of reduced efficacy of triptorelin. Reserpine can cause hyperprolactinemia, which reduces the number of pituitary gonadotropin releasing hormone (GnRH) receptors; triptorelin is a GnRH analog.
    Valdecoxib: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease.
    Ziprasidone: (Minor) Ziprasidone is a moderate antagonist of alpha-1 receptors and may cause orthostatic hypotension with or without tachycardia, dizziness, or syncope. Additive hypotensive effects are possible if ziprasidone is used concurrently with antihypertensive agents.

    PREGNANCY AND LACTATION

    Pregnancy

    Reserpine is not recommended for use during pregnancy and is considered to most closely correspond to an FDA pregnancy risk category D (manufacturer lists as FDA pregnancy risk category C). Animal reproduction studies have suggested adverse fetal effects. Reserpine administered parenterally has been shown to be teratogenic in rats at doses up to 2 mg/kg and to have an embryocidal effect in guinea pigs given dosages of 0.5 mg daily. Reserpine crosses the placental barrier, and increased respiratory tract secretions, nasal congestion, cyanosis, and anorexia may occur in neonates of reserpine-treated human mothers.

    According to the manufacturer, reserpine should not be used in breast-feeding women. Reserpine is excreted into breast milk in significant amounts to cause increased respiratory tract secretions, nasal congestion, cyanosis, and anorexia in breast-feeding infants. Because of the potential for adverse reactions in nursing infants and the potential for tumorigenicity shown for reserpine in animal studies, a decision should be made whether to discontinue nursing or to discontinue the drug. An alternative agent for blood pressure treatment is preferred. The American Academy of Pediatrics (AAP) has not evaluated the use of reserpine in breast-feeding mothers. The AAP regards alternative agents, such as enalapril, hydrochlorothiazide, methyldopa, nifedipine, and propranolol as usually compatible with breast-feeding. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.

    MECHANISM OF ACTION

    Mechanism of Action: Reserpine depletes stores of serotonin and norepinephrine in the brain, adrenal medulla, and other tissues, and reduces the reuptake of catecholamines by adrenergic nerve terminals. The drug binds tightly to catecholamine storage vesicles in the adrenergic neuron, eventually destroying these vesicles so that the terminals cannot concentrate or store norepinephrine or dopamine. This process also occurs in vesicles that store serotonin (5-hydroxytryptamine). The result of reserpine's effects on biogenic amines is sympathetic dysfunction, with a subsequent decrease in peripheral vascular resistance and a lowering of blood pressure often associated with bradycardia. Cardiac output, renal blood flow, and glomerular filtration rate are also decreased. After reserpine is discontinued, the synthesis of new vesicles can restore sympathetic function, but this can take several weeks.
    Reserpine produces a tranquilizing effect by depletion of catecholamines in the brain. Convulsions and extrapyramidal effects have occurred following high doses of reserpine. Respiratory stimulation occurs at small doses and respiratory depression occurs with large doses. Additionally, reserpine-induced adrenergic blockade results in increased parasympathomimetic effects including increased gastric acid secretion, GI hypermotility, and miosis. As an antihypertensive, reserpine decreases LVH and does not worsen insulin resistance, however, sexual dysfunction occurs frequently, particularly in males.

    PHARMACOKINETICS

    Reserpine is administered orally. The drug distributes throughout the body tissues and is completely metabolized in the liver to inactive derivatives. Reserpine that is bound to vesicles cannot be removed with dialysis, indicating that the amount of drug bound to vesicles and the amount present in the medium are not in equilibrium. Metabolites of the drug are excreted gradually in the urine and feces; antihypertensive effects can last for weeks following discontinuance of therapy.

    Oral Route

    Reserpine is absorbed rapidly from the GI tract following oral administration, but the hypotensive effects usually are not observed for 2—3 weeks.