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RAUWOLFIA ALKALOIDS AND THIAZIDE DIURETICS (Systemic)
Some commonly used brand names are:
In the U.S.—
Rauwolfia alkaloid and thiazide diuretic combinations are used in the treatment of high blood pressure (hypertension).
High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.
Rauwolfia alkaloids work by controlling nerve impulses along certain nerve pathways. As a result, they act on the heart and blood vessels to lower blood pressure. Thiazide diuretics help to reduce the amount of water in the body by increasing the flow of urine. This also helps to lower blood pressure.
These medicines are available only with your doctor"s prescription, in the following dosage forms:
Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For rauwolfia alkaloids and thiazide diuretics, the following should be considered:
Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to sulfonamides (sulfa drugs), thiazide diuretics (water pills), or rauwolfia alkaloids. Also tell your health care professional if you are allergic to any other substance, such as foods, preservatives, or dyes.
Pregnancy—Too much use of thiazide diuretics (contained in this combination medicine) during pregnancy may cause unwanted effects including jaundice, blood problems, and low potassium in the baby. Too much use of rauwolfia alkaloids may cause difficult breathing, low temperature, and loss of appetite in the baby. This medicine has not been shown to cause birth defects in humans. In rats, use of rauwolfia alkaloids during pregnancy decreases newborn survival rates. Be sure that you have discussed this with your doctor before taking this medicine.
Breast-feeding—Rauwolfia alkaloids pass into breast milk and may cause unwanted effects (difficult breathing, low temperature, loss of appetite) in infants of mothers taking it in large doses. Thiazide diuretics also pass into breast milk. Be sure you have discussed this with your doctor before taking this medicine.
Children—Although there is no specific information comparing use of these medicines in children with use in other age groups, these medicines are not expected to cause different side effects or problems in children than they do in adults.
Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults. Although there is no specific information comparing use of rauwolfia alkaloid and thiazide diuretic combinations in the elderly with use in other age groups, this medicine is not expected to cause different side effects or problems in older people than it does in younger adults. However, drowsiness, dizziness, or faintness or symptoms of too much potassium loss may be more likely to occur in the elderly, who are more sensitive to the effects of rauwolfia alkaloids and thiazide diuretics.
Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking rauwolfia alkaloids and thiazide diuretics, it is especially important that your health care professional know if you are taking any of the following:
Other medical problems—The presence of other medical problems may affect the use of rauwolfia alkaloids and thiazide diuretics. Make sure you tell your doctor if you have any other medical problems, especially:
Proper Use of This Medicine
In addition to the use of the medicine your doctor has prescribed, treatment for your high blood pressure may include weight control and care in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.
Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.
Remember that this medicine will not cure your high blood pressure but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life . If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.
This medicine may cause you to have an unusual feeling of tiredness when you begin to take it. You may also notice an increase in the amount of urine or in your frequency of urination. After you have taken the medicine for a while, these effects should lessen. In general, to keep the increase in urine from affecting your sleep:
However, it is best to plan your dose or doses according to a schedule that will least affect your personal activities and sleep. Ask your health care professional to help you plan the best time to take this medicine.
To help you remember to take your medicine, try to get into the habit of taking it at the same time each day.
If this medicine upsets your stomach, it may be taken with meals or milk. If stomach upset (nausea, vomiting, stomach pain or cramps) continues, check with your doctor.
Dosing—The dose of these medicines will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.
Missed dose—If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Storage—To store this medicine:
Precautions While Using This Medicine
It is important that your doctor check your progress at regular visits to make sure that this medicine is working properly.
Do not take other medicines unless they have been discussed with your doctor . This especially includes over-the-counter (nonprescription) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may tend to increase your blood pressure.
Before having any kind of surgery (including dental surgery), or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine .
This medicine may cause a loss of potassium from your body.
Check with your doctor if you become sick and have severe or continuing vomiting or diarrhea. These problems may cause you to lose additional water and potassium.
This medicine may cause some people to become drowsy or less alert than they are normally. This is more likely to happen when you begin to take it or when you increase the amount of medicine you are taking. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert .
Dizziness, lightheadedness, or fainting may occur, especially when you get up from a lying or sitting position . This is more likely to occur in the morning. Getting up slowly may help. When you get up from lying down, sit on the edge of the bed with your feet dangling for 1 or 2 minutes. Then stand up slowly. If the problem continues or gets worse, check with your doctor.
The dizziness, lightheadedness, or fainting is also more likely to occur if you drink alcohol, stand for a long time, exercise, or if the weather is hot. While you are taking this medicine, be careful to limit the amount of alcohol you drink. Also, use extra care during exercise or hot weather or if you must stand for a long time .
In some patients, this medicine may cause mental depression. Tell your doctor right away :
This medicine will add to the effects of alcohol and other CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including dental anesthetics. Check with your doctor before taking any of the above while you are taking this medicine .
For diabetic patients :
Some people who take this medicine may become more sensitive to sunlight than they are normally. Exposure to sunlight, even for brief periods of time, may cause severe sunburn; skin rash, redness, itching, or discoloration; or vision changes. When you begin taking this medicine:
If you have a severe reaction from the sun, check with your doctor.
This medicine often causes stuffiness in the nose. However, do not use nasal decongestant medicines without first checking with your health care professional.
This medicine may cause dryness of the mouth. For temporary relief, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. However, if dry mouth continues for more than 2 weeks, check with your medical doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.
Side Effects of This Medicine
Suggestions that rauwolfia alkaloids may increase the risk of breast cancer occurring later have not been proven. However, rats and mice given 100 to 300 times the human dose had an increased risk of tumors.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur :
Drowsiness or faintness; impotence or decreased sexual interest; lack of energy or weakness; mental depression or inability to concentrate; nervousness or anxiety; vivid dreams or nightmares or early-morning sleeplessness
Check with your doctor as soon as possible if any of the following side effects occur:
Black, tarry stools; bloody vomit; chest pain; headache; irregular or slow heartbeat; joint pain; shortness of breath
Painful or difficult urination; skin rash or itching; sore throat and fever; stiffness; stomach pain (severe) with nausea and vomiting; trembling and shaking of hands and fingers; unusual bleeding or bruising; yellow eyes or skin
Symptoms of too much potassium loss or overdose
Dry mouth; increased thirst; muscle cramps or pain; nausea or vomiting
Other signs and symptoms of overdose
Dizziness or drowsiness, severe; flushing of skin; pinpoint pupils of eyes; slow pulse
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:
Diarrhea; dizziness, especially when getting up from a lying or sitting position; loss of appetite; stuffy nose
After you stop using this medicine, it may still produce some side effects that need attention. During this period of time check with your doctor immediately if you notice any of the following side effects:
Drowsiness or faintness; impotence or decreased sexual interest; irregular or slow heartbeat; lack of energy or weakness; mental depression or inability to concentrate; nervousness or anxiety; vivid dreams or nightmares or early-morning sleeplessness
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.
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