Generic Name: hydralazine/hydrochlorothiazide/reserpine (hye DRAL a zeen/hye droe klor oh THYE a zide/re SER peen)Brand names: Diuretic Ap-Es, Hydrap-ES, Ser-Ap-Es, Serpazide, Tri-Hydroserpine, Uni Serp, Marpres, Serathide, Unipres, Serpex, HHR
Hydralazine is a vasodilator. It lowers blood pressure by relaxing (widening) blood vessels (veins and arteries) and making it easier for your heart to pump.
Hydrochlorothiazide is a thiazide diuretic (water pill). It helps to lower your blood pressure and decrease edema (swelling or water retention) by increasing the amount of salt and water you lose in your urine.
Reserpine lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels (veins and arteries) to relax and your heart to beat more slowly and easily.
The combination, hydralazine/hydrochlorothiazide/reserpine, is used to lower high blood pressure.
Hydralazine/hydrochlorothiazide/reserpine may also be used for purposes other than those listed in this medication guide.What is the most important information I should know about hydralazine/hydrochlorothiazide/reserpine?Stand up slowly from a sitting or lying position. Hydralazine/hydrochlorothiazide/reserpine may make you feel dizzy. Do not stop taking hydralazine/hydrochlorothiazide/reserpine suddenly. Even if you feel better, you need this medication to control your condition. Stopping suddenly could cause severely high blood pressure, anxiety, and other dangerous side effects. Use caution when driving, operating machinery, or performing other hazardous activities. Hydralazine/hydrochlorothiazide/reserpine may cause dizziness. If you experience dizziness, avoid these activities. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking this medication.What should I discuss with my healthcare provider before taking hydralazine/hydrochlorothiazide/reserpine?Do not take hydralazine/hydrochlorothiazide/reserpine without first talking to your doctor if you
have an allergy to sulfa-based drugs such as sulfa antibiotics;
have coronary heart disease or mitral valvular rheumatic heart disease;
have peptic ulcer disease (stomach ulcers);
have ulcerative colitis;
are suffering from depression (especially if you have suicidal thoughts);
are receiving electroconvulsive shock therapy; or
have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days.
You may not be able to take hydralazine/hydrochlorothiazide/reserpine if you have any of the conditions listed above.
Before taking this medication, tell your doctor if you
have a collagen vascular disease such as systemic lupus erythematosus,
have any type of heart disease,
have had a stroke or a transient ischemic attack (mini-stroke),
have high cholesterol or high levels of fat in your blood, or
have pulmonary hypertension (a type of lung disease).
You may require a dosage adjustment or special monitoring during therapy with hydralazine/hydrochlorothiazide/reserpine if you have any of the conditions listed above.Hydralazine/hydrochlorothiazide/reserpine is in the FDA pregnancy category C. This means that it is not known whether hydralazine/hydrochlorothiazide/reserpine will harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant. Hydralazine/hydrochlorothiazide/reserpine passes into breast milk and may harm a nursing infant. Do not take this medication without first talking to your doctor if you are breast-feeding a baby. If you are over 60 years of age, you may be more likely to experience side effects from hydralazine/hydrochlorothiazide/reserpine therapy. You may require a lower dose of this medication.
Take the medication exactly as directed. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.Take each dose with a full glass of water. Take the medication with food or milk if it upsets your stomach.
Do not suddenly stop taking hydralazine/hydrochlorothiazide/reserpine. Stopping suddenly could make your condition much worse or cause very serious side effects. Talk to your doctor before you stop taking this medication.Store this medication at room temperature away from moisture and heat.
See also: Hydralazine/hydrochlorothiazide/reserpine dosage in more detail
Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the dose you missed and take only your next regularly scheduled dose. Do not take a double dose of this medication.
Symptoms of an overdose include low blood pressure (fainting, dizziness, weakness), slow pulse or an irregular heartbeat, low body temperature, diarrhea, increased urination, vomiting, headache, flushing of the skin, and slow breathing.
Do not let yourself become overheated in hot weather or during exercise, and use caution if you have a fever. Dehydration may increase the effects of hydralazine/hydrochlorothiazide/reserpine, and you may become very dizzy.Avoid prolonged exposure to sunlight. Hydrochlorothiazide may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable.
an allergic reaction (difficulty breathing, closing of your throat, swelling of your lips, tongue or face, hives);
irregular or fast heartbeats or a fluttering feeling in your chest;
new or worsening chest pain;
heart failure (shortness of breath, swelling of ankles or legs, sudden weight gain of 2 pounds in one day or 5 pounds in one week);
unusual fatigue or confusion;
abnormal bleeding or bruising;
yellow skin or eyes;
blood in your urine or stools;
little or no urine;
numbness, tingling, pain, or weakness of your arms or legs; or
Other, less serious side effects are more likely to occur. Continue to take hydralazine/hydrochlorothiazide/reserpine and talk to your doctor if you experience
mild fatigue, drowsiness, or dizziness;
water retention (swelling of the hands, feet, or ankles);
anxiety, depression, or nightmares;
diarrhea, nausea, vomiting , abdominal pain;
stuffy nose or a dry mouth;
muscle weakness or cramps;
increased hunger, thirst, or urination;
sensitivity to sunlight; or
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
Usual Adult Dose for Hypertension:
Initial dose: 1 tablet orally once a day. Maintenance dose: 1 to 2 tablets/day in 1 to 2 divided doses. Dosage should be determined by individual titration.Dosage regimens that exceed 0.25 mg of reserpine per day are not recommended.
Do not take this medication if you have taken a monoamine oxidase inhibitor (MAOI), such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate), in the last 14 days.
Before taking this medication, tell your doctor if you are taking any of the following drugs:
digoxin (Lanoxin, Lanoxicaps);
quinidine (Cardioquin, others);
lithium (Lithobid, Eskalith, others);
an antidiabetic medicine such as glipizide (Glucotrol), glyburide (Micronase, Glynase, Diabeta), and others; or
a steroid medicine such as prednisone (Orasone, Deltasone), prednisolone (Delta Cortef, Prelone), methylprednisolone (Medrol), and others.
You may not be able to take hydralazine/hydrochlorothiazide/reserpine, or you may require a dosage adjustment or special monitoring during your treatment if you are taking any of the medicines listed above.
Also, before taking hydralazine/hydrochlorothiazide/reserpine, tell your doctor if you are taking any medicine to treat high blood pressure, water retention, heart problems, prostate problems, or another condition. Some medicines used to treat these conditions may interact with hydralazine/hydrochlorothiazide/reserpine, and the interaction may increase the effects on your heart.
Hydralazine/hydrochlorothiazide/reserpine may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any medicine unless your doctor approves.
Drugs other than those listed here may also interact with hydralazine/hydrochlorothiazide/reserpine or affect your condition. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.
Hydralazine/hydrochlorothiazide/reserpine is available with a prescription under the brand name Ser-Ap-Es. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.
Hydralazine/hydrochlorothiazide/reserpine strengths are as follows:
Ser-Ap-Es (25 mg/15 mg/0.1mg)--round, salmon-pink, dry-coated tablets