Pharmacology and toxicology

Reserpine, a sympatholytic that causes the depletion of catecholamines and serotonin in tissues throughout the body, is well-absorbed orally. In the past, reserpine was used frequently for long-term therapy in cases of hypertensive pregnancy complications (Towel1 1966).

A number of case reports of fetal and neonatal toxicity have been reported following exposure in pregnancy, but no pattern of defects was observed and no causal relationship has been established. In contrast, there have been several reports of normal outcomes in pregnancies involving exposure to rcserpinc (Czcizcl 1988, Heinonen 1977). Occasional breathing and sucking disturbances have been observed in newborns following exposure to rescrpine in the third trimester of pregnancy.

Reserpine has been largely displaced by the newer classes of antihypertensives because of its numerous side effects, including postural hypotension, cardiac arrhythmias, gastric ulceration, and diarrhea. Depletion of brain amines and serotonin can also cause depression and behavioral changes, and chronic use may induce extrapyramidal effects.

Recommendation. Reserpine is no longer considered to be a drug of choice for the majority of pregnant hypertensive women because of the numerous associated side effects and the possibility of alterations In fetal brain development; d-blockers such as metoprolol, a-methyldopa, (di)hydralazine, and nifidipine are less toxic to the mother and fetus and are the preferred drugs of choice. However, the inadvertent use of reserpine, or its use in specific clinical conditions, is no reason for termination of pregnancy or for additional diagnostic procedures in the absence of severe maternal toxicity.

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