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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

What is hydralazine/hydrochlorothiazide/reserpine?

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?

What should I discuss with my healthcare provider before taking hydralazine/hydrochlorothiazide/reserpine?

• 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 gallstones,

• have kidney or liver disease,

• have diabetes,

• have gout,

• have a collagen vascular disease such as systemic lupus erythematosus,

• have pancreatitis,

• have asthma,

• 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.

How should I take hydralazine/hydrochlorothiazide/reserpine?

Take the medication exactly as directed. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

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.

What happens if I miss a dose?

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.

What happens if I overdose?

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.

What should I avoid while taking hydralazine/hydrochlorothiazide/reserpine?

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.

What are the possible side effects of hydralazine/hydrochlorothiazide/reserpine?

• 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

• fainting.

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;

• headache;

• 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;

• a rash;

• sensitivity to sunlight; or

• impotence or difficulty ejaculating.

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.

What other drugs will affect hydralazine/hydrochlorothiazide/reserpine?

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);

• a tricyclic antidepressant such as amitriptyline (Elavil, Endep), imipramine (Tofranil), nortriptyline (Pamelor), doxepin (Sinequan), and others;
• a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Motrin, Advil), ketoprofen (Orudis, Orudis KT, Oruvail), naproxen (Naprosyn, Anaprox, Aleve), and 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.

Where can I get more information?

• Your pharmacist has additional information about hydralazine/hydrochlorothiazide/reserpine written for health professionals that you may read.

What does my medication look like?

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

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.