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Rauvolfia serpentina
Rheum officinale
Rhamnus frangula
Rhamnus purshiana
Rehmannia glutinosa


 

 

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Untitled Document Rauvolfia serpentina (L.) Benth. ex Kurz (Apocynaceae)

Synonyms
Ophioxylon obversum Miq., O. sautiferum Salisb., O. serpentinum L., Rauvolfia obversa (Miq.) Baill., R. trifoliata (Gaertn.) Baill.

Local names
Most commonly called “rauwolfia”. Acawerya, aika-wairey, akar-tikos, arsol, bhudra, bongmaiza, chandmaruwa, chandra, chandrika, chotachand, chotachard, chundrika, chundrooshoora, churmuhuntree, chuvannayilpuri, covanamilpori, covannamipori, dhanbarua, dhannerna, dogrikme, eiya-kunda, ekaweriya, garudpathal, hadki, harkai, harkaya, ichneumon plant, Indian snakeroot, indojaboku, karai, karavi, karuvee, makeshwar chadrika, makeshwar churna, matavi-aloos, nogliever, nundunee, pagla-ka-dawa, palalganni, patalaagandhi, poelé pandak, poeleh pandak, pushoomehnunkarika, ra-yom, radix mungo, radix mustelae, raiz de mongo alba, rametul, ratekaweriya, rayom noi, rauvolfia, rauwalfia, rauwolfia, Rauwolfiawurzel, sanochado, sapasan, sarpagandha, sarpgandha, serpentina, sjouanna-amelpodi, snakeroot, sung, suvapaval-amepodi, talona, vasoopooshpa, vasura

Description
Small, erect, glabrous shrub, 30–60 cm high. Leaves whorled, 7.5–17.5 cm long, lanceolate or oblanceolate, acute or acuminate, tapering gradually into the petiole, thin. Flowers white or pinkish; peduncles 5.0–7.5 cm long; pedicels and calyx red. Calyx lobes 2.5 mm long, lanceolate. Corolla about 1–1.3cm long; tube slender; inflated slightly above middle; lobes much shorter than tube, obtuse. Drupes about 6 mm (diameter), single or didymous and more or less connate, purplish black when ripe

Plant material used
root

Chemical assays
Contains not less than 1% total alkaloids; and a minimum of 0.1% alkaloids of the reserpine–rescinnamine group.Thin-layer chromatography to detect the presence of the reserpine– rescinnamine group of alkaloids. Quantitative analysis of total and reserpine–rescinnamine group of alkaloids can be performed by spectrophotometric analysis or by high-performance liquid chromatography

Major chemical constituents
Radix Rauwolfiae contains more than 60 indole alkaloids; the principal hypotensive alkaloids are identified as reserpine and rescinnamine

Dosage forms
Crude drug and powder. Package in well-closed containers and store at 15–25°C in a dry place, secure against insect attack.

Medicinal uses
Uses supported by clinical data
The principal use today is in the treatment of mild essential hypertension. Treatment is usually administered in combination with a diuretic agent to support the drug’s antihypertensive activity, and to prevent fluid retention which may develop if Radix Rauwolfiae is given alone.

Uses described in pharmacopoeias and well established documents
As a tranquillizer for nervous and mental disorders.

Uses described in traditional medicine
As a tonic in states of asthenia, a cardiotonic and antipyretic; against snake and insect bites; and for constipation, liver diseases, flatulence, insomnia, and rheumatism

Proven pharmacological activity
Animal studies
Antihypertensive

Human studies
Antihypertensive

Contraindications
Radix Rauwolfiae products are contraindicated in patients who have previously demonstrated hypersensitivity to the plant or its alkaloids. They are also contraindicated in patients with a history of mental depression (especially those with suicidal tendencies) during or shortly after therapy with monoamine oxidase inhibitors; active peptic ulcer, sinus node disorders, ulcerative colitis; epilepsy; or decreased renal function; and in patients receiving electroconvulsive therapy.

Warnings
Radix Rauwolfiae products may cause mental depression. Recognition of depression may be difficult because this condition may often be disguised by somatic complaints (masked depression). The products should be discontinued at first signs of depression such as despondency, early morning insomnia, loss of appetite, impotence, or self-deprecation. Drug-induced depression may persist for several months after drug withdrawal and may be severe enough to result in suicide. Sensitivity reactions may occur in patients with or without a history of allergy or bronchial asthma. The use of Radix Rauwolfiae products may impair alertness and make it inadvisable to drive or operate heavy machinery

Precautions
General
Because Radix Rauwolfiae preparations increase gastrointestinal motility and secretion, they should be used cautiously in persons with a history of peptic ulcer, ulcerative colitis, or gallstones where biliary colic may be precipitated. Persons on high doses should be observed carefully at regular intervals to detect possible reactivation of peptic ulcer. Caution should be exercised when treating hypertensive patients with renal insufficiency since they adjust poorly to lowered blood-pressure levels.

Drug interactions
When administered concurrently, the following drugs may interact with or potentiate Radix Rauwolfiae and its alkaloids: alcohol or other central nervous system depressants, other antihypertensives or diuretics, digitalis glycosides or quinidine, levodopa, levomepromazine, monoamine oxidase inhibitors, sympathomimetics (direct-acting) and tricyclic antidepressants. Concomitant use of Radix Rauwolfiae products and anaesthetics may provoke a fall in blood pressure and add to the -adrenoceptor–blocking activity of propranolol.

Drug and laboratory test interactions
Chronic administration of Radix Rauwolfiae preparations may increase serum prolactin levels and decrease excretion of urinary catecholamines and vanilmandelic acid. Therefore, any diagnostic tests performed for these determinations should be interpreted with caution. Radix Rauwolfiae preparations slightly decrease absorbance readings obtained on urinary steroid colorimetric determinations (e.g. modified Glenn– Nelson technique or Holtorff Koch modification of Zimmermann reaction), and thus false low results may be reported. Preoperative withdrawal of Radix Rauwolfiae products does not necessarily ensure circulatory stability during the procedure, and the anaesthetist must be informed of the patient’s drug history. Caution is indicated in elderly patients and also in those suffering from coronary and cerebral arteriosclerosis. Administration of products including Radix Rauwolfiae preparations at doses that might precipitate a sharp decrease in blood pressure should be avoided.

Carcinogenesis, mutagenesis, impairment of fertility
Animal carcinogenicity studies using reserpine at doses 50 times as high as the average human dose have been conducted with rats and mice. Carcinogenic effects associated with the administration of reserpine include an increased incidence of adrenal medullary phaeochromocytomas in male rats, unidentified carcinomas of the seminal vesicles in male mice, and mammary cancer in female mice; carcinogenic effects were not seen in female rats. Bacteriological studies to determine mutagenicity using reserpine showed negative results. The extent of risk to humans is uncertain.

Pregnancy: teratogenic effects
Reserpine, the major active alkaloid in Radix Rauwolfiae, administered parenterally has been shown to be teratogenic in rats at doses up to 2mg/kg and to have an embryocidal effect in guinea-pigs at 0.5 mg daily. There are no adequate and well-controlled studies in pregnant women.

Pregnancy: non-teratogenic effects
Increased respiratory secretions, nasal congestion, cyanosis, hypothermia, and anorexia have occurred in neonates of mothers treated with Radix Rauwolfiae. Therefore, the use of Radix Rauwolfiae is not recommended during pregnancy.

Nursing mothers
Rauwolfia alkaloids are excreted in human milk. Because of the potential for serious adverse reactions in nursing infants, use of Radix Rauwolfiae during lactation is not recommended.

Paediatric use
Safety and effectiveness in children have not been established.

Adverse reactions
The following adverse reactions have been observed, but there are insufficient data to support an estimate of their frequency. The reactions are usually reversible and disappear when the Radix Rauwolfiae preparations are discontinued.
Cardiovascular system: bradycardia, arrhythmias, particularly when used concurrently with digitalis or quinidine, angina-like symptoms. Water retention with oedema in persons with hypertensive vascular disease may occur rarely, but the condition generally clears with cessation of therapy, or the administration of a diuretic agent. Vasodilation produced by rauwolfia alkaloids may result in nasal congestion, flushing, a feeling of warmth, and conjunctival congestion.
Central nervous system: sensitization of the central nervous system manifested by optic atrophy, glaucoma, uveitis, deafness, and dull sensorium. Other reactions include depression, paradoxical anxiety, nightmares, nervousness, headache, dizziness, drowsiness. Large doses have produced parkinsonian syndrome, other extrapyramidal reactions, and convulsions.
Gastrointestinal system: hypersecretion and increased intestinal motility, diarrhoea, vomiting, nausea, anorexia, and dryness of mouth. Gastrointestinal bleeding has occurred in isolated cases
Respiratory system: dyspnoea, epistaxis, nasal congestion.
Hypersensitivity: purpura, pruritus, rash.
Other: dysuria, muscular aches, weight gain, breast engorgement, pseudolactation, impotence or decreased libido, gynaecomastia.

Posology
Powder, 200 mg daily in divided doses for 1–3 weeks; maintenance 50–300mg daily. Doses of other preparations should be calculated accordingly. Doses of Radix Rauwolfiae should be based on the recommended dosage of rauwolfia alkaloids, which must be adjusted according to the patient’s requirements and tolerance in small increments at intervals of at least 10 days. Debilitated and geriatric patients may require lower dosages of rauwolfia alkaloids than do other adults. Rauwolfia alkaloids may be administered orally in a single daily dose or divided into two daily doses

 

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