INDICES> Reserpine availability (3)

[Gunnar Holmgren <gunnar.holmgren@kbh.uu.se>]

INDICES> reserpine availability? (3)
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In reply to the message from  Dr. L. Offerhaus I'm sure he knows of the
excellent clinical trial that was done in London in the late 60's or early
70's where it was shown very clearly that reserpine on its own is not a
good drug for use in treating hypertension. However reserpine in
combination with a thiazide diuretic, brought in for the 60% of moderately
severe and severe hypertension who were not controlled by thiazide
diuretics alone, in a dose of 0.25mg daily was an excellent drug and
brought 80% of patients under good control. There was no depression at this
dose, and other side-effects were less than the best other treatment
available at that time. The conclusion was: don't ever use reserpine on its
own; always use it as a second drug in combination with thiazide diuretics
when the latter is not enough on its own; don't exceed 0.3 mg per day. This
trial was so impressive that many academic departments of medicine in
Britain went over to using this combination in the early 70's despite
reserpine's bad image. A friend of mine in London is just in the process of
repeating this trial now as a stricter double-blind randomized controlled
trial since the pilot study done recently in a London academic department
showed such an impressive result.

I am writing this reply at a site where I don't have access to any
references but can dig those up for you when I am back in my usual place of
work. My clear judgement is that reserpine got its bad name when it was
used in a wrong way and at a wrong dose. Used in the way I have described
it is a valuable and cheap alternative to other much more expensive drugs
and maybe the best drug combination to be highly recommended in a setting
with very limited resources.

Gunnar Holmgren, MRCP
Consultant in International Health Care,
Department of Women's and Children's Health,
Uppsala University, Sweden

Email: gunnar.holmgren@kbh.uu.se  [added by moderator; WB]

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