Rauwolfia. Medicinal reference book geotar rauwolfia serpentine in latin

Other plant names:

serpentina, sarpagandha.

A brief description of the snake rauwolfia:

Rauwolfia serpentine (serpentine) is a shrub up to 1–1.5 m high, of the Apocynaceae family.

Rauwolfia serpentine (serpentine) grows in tropical countries.

The roots and rhizomes of rauwolfia are harvested, from which the medical industry produces reserpine, raunatin, aymalin.

Chemical composition of rauwolfia snakes:

Rhizomes and roots of rauwolfia contain about 20 indole alkaloids, which, in terms of dry plant raw materials, are 1–2%. The most famous of them are reserpine, reserpinine, raupine, serpentine, rescinamine, aymalicin, aymalin, aymalinin, serpin, yohimbine, thebaine, papaverine, etc.

All of these active ingredients form the basis of the chemical composition of the serpentine rauwolfia (serpentines).

Pharmacological properties of rauwolfia snakes:

The pharmacological properties of rauwolfia are determined by its chemical composition.

The pharmacological properties of plant alkaloids are diverse. Basically, they affect the central nervous system, have a hypotensive and adrenolytic effect, which is mainly due to the specific properties of reserpine and the amount of alkaloids close to it in structure. In connection with the widespread use in medical practice of reserpine and total alkaloid preparations from rauwolfia, the pharmacological properties of reserpine and raunatin are presented below.

Reserpine:

Reserpine is a white crystalline powder, poorly soluble in water and well in organic solvents. It has mainly hypotensive and sedative (tranquilizing) effects.

The antihypertensive effect of reserpine develops slowly and persists for a long time. The hypotensive effect is associated with a decrease in cardiac output of blood, with a decrease in the total peripheral vascular resistance, as well as with the presence of an inhibitory effect of the drug on the pressor centers. The direct effect of the rauwolfia alkaloid on the vasomotor centers has not yet been proven, since reserpine in an animal experiment does not affect efferent impulses in the preganglionic fibers of the sympathetic innervation. Under the action of reserpine, however, bradycardia, increased motor activity and secretion of the gastrointestinal tract, as well as miosis are observed, which indicates the suppression of adrenergic mechanisms by the drug and the predominance of cholinergic effects.

The effect of reserpine on the central nervous system is manifested in the deepening and intensification of physiological sleep, in the potentiation of the action of barbiturates and other hypnotics and drugs, in the inhibition of interoreceptive reflexes, in a decrease in body temperature. All this makes it possible to classify reserpine as a neuroleptic. However, at present, reserpine is rarely used in practical medicine as a neuroleptic.

The mechanism of action of reserpine is associated with its effect on biogenic amines, although it does not belong to monoamine oxidase inhibitors. In an experiment on animals, with the introduction of the rauwolfia alkaloid in large doses, the content of biogenic amines in the central nervous system and other organs and tissues is noticeably reduced. For example, the content of catecholamines in the central nervous system of norepinephrine decreases - in the heart muscle, blood vessels, adrenal medulla.

Raunatin:

In contrast to the individual plant alkaloid, the total drug from rauwolfia serpentine - raunatin - has a milder hypotensive and sedative effect, however, due to other plant alkaloids, it also has antiarrhythmic and antispasmodic properties. Despite the fact that in terms of the strength of the hypotensive effect, raunatin is inferior to reserpine, the mechanism for lowering the blood pressure of raunatin is composed of two components - a central reserpine-like and peripheral adrenolytic effect.

The use of rauwolfia in medicine, the treatment of rauwolfia. Dosage forms, method of administration and dosage of rauwolfia snakes' preparations:

From the rhizomes and roots of rauwolfia, effective medicinal preparations and forms are made that are used in the treatment of many diseases. Let's consider the main ones.

Reserpine drug:

Reserpine (Reserpinum) is used mainly for hypertension. Under the influence of the drug, there is a gradual decrease in the maximum and minimum blood pressure in various forms of hypertension (including with hyperfunction of the thyroid gland). The greatest effect is observed in the early stages of the disease in the absence of organic changes in the cardiovascular system. The therapeutic effect of reserpine usually appears 3–6 days after the start of the drug. The antihypertensive effect persists for a relatively long time after discontinuation of reserpine. It is usually prescribed by mouth in the form of tablets; sometimes administered intramuscularly or intravenously, but parenteral administration does not have significant advantages over oral administration of the drug.

Doses of the drug and the duration of its use should be individualized. In hypertension, usually begin with the appointment of reserpine at a dose of 0.1–0.3 mg / day (0.0001–0.0003 g / day); take the drug reserpine after meals. In some cases, it is enough to continue using the drug in these doses, in other cases, the dose is gradually increased to 0.5–1 mg / day; in the absence of effect, the dose can be increased to 1.5–2 mg / day. If within 10-14 days the hypotensive effect does not occur, further administration of the drug is canceled. If there is an effect, the dose is gradually reduced to 0.5-0.2-0.1 mg / day. Treatment with small (maintenance) doses is carried out for a long time for several months under the supervision of a physician.

If necessary, you can prescribe reserpine in conjunction with other antihypertensive drugs, especially with apressin, as well as hexonium, pentamine and other ganglion blocking drugs.

The drug reserpine is also used for mild forms of heart failure with tachycardia (together with cardiac glycosides), for hypersympathicotonia, thyrotoxicosis (together with thyrostatic substances), and for late pregnancy toxicosis.

Higher doses of reserpine for adults inside: single 0.001 g (1 mg), daily 0.01 g (10 mg). When prescribing the drug in higher doses, an appropriate indication should be made in the prescription.

For children, reserpine is prescribed at the age of up to 1 year no more than 0.1 mg 1-2 times a day, up to 5 years old - 0.1 mg 2 times a day and from 6 to 12 years old - 0.1 mg 2-3 times a day ...

In small doses, reserpine, as a rule, does not cause side effects. At high doses and increased sensitivity, there may be hyperemia of the mucous membranes of the eyes, skin rash, stomach pain, diarrhea, bradycardia, weakness, dizziness, shortness of breath, nausea, vomiting, nightmares. With prolonged use, parkinsonism is possible.

During the course of treatment, patients with mental illness may develop feelings of anxiety, anxiety, persistent insomnia, and a state of depression.

In case of side effects, the dose of reserpine should be reduced or temporarily canceled. For pain in the stomach and diarrhea, anticholinergics are prescribed, for parkinsonism - atropine, tropacin, amisil or similar drugs. With severe depression, CNS stimulants are used. When prescribing the drug on an outpatient basis, the possibility of drowsiness and general weakness should be taken into account.

Contraindications for reserpine: Reserpine is contraindicated in severe organic cardiovascular diseases with circulatory failure and severe bradycardia, in coronary sclerosis and sclerosis of the cerebral vessels, nephrosclerosis, gastric ulcer and duodenal ulcer.

Available in the form of powder and tablets of 0.0001 g (0.1 mg) and 0.00025 g (0.25 mg).

Reserpine in powder is kept under lock and key (list A); tablets - with a precaution (list B). Store the drug reserpine in a tightly sealed container in a dry, dark place.

The drug raunatin:

Raunatin. The main indication for the use of raunatin is hypertension, especially in stages I and II. In psychiatric practice, raunatin is not widely used due to an insufficiently pronounced neuroleptic effect, but it can, however, be used for neurotic conditions.

Prescribe the drug inside in tablets. Usually start with taking 1 tablet containing 0.002 g (2 mg) of the amount of alkaloids at night; on the 2nd day, take 1 tablet 2 times a day; on the 3rd day - 3 tablets and adjust the total daily dose of the drug to 5-6 tablets per day; take raunatin after meals.

After the onset of the therapeutic effect (usually after 10-14 days), the dose is gradually reduced to 1-2 tablets per day. The course of treatment lasts 3-4 weeks. However, sometimes the drug is taken for a rather long time in a maintenance dose (1 tablet per day). Treatment with raunatin should be carried out under the supervision of a physician. Simultaneously with raunatin (or sequentially), you can use other antihypertensive drugs, ganglion blocking drugs, apressin, dichlothiazide, etc.

Raunatin usually does not cause side effects. Some patients tolerate it better than reserpine. However, in some cases, there is swelling of the mucous membranes of the nose, sweating, general weakness; in patients with angina pectoris, pain in the region of the heart sometimes increases. Side effects disappear when the dose is reduced or after a short break (1-3 days) in taking the drug.

Raunatin is produced in coated tablets containing 0.002 g (2 mg) of the drug. Storage: List B. Store the drug raunatin in well-sealed jars or dark glass vials.

Aymalin preparation:

Ajmalin (Ajmalinum) on chemical structure belongs to the group of indole derivatives and is a white or white crystalline powder with a slightly yellowish tinge. Let's very little dissolve in water, it is difficult - in alcohol. Aymaline hydrochloride and acetate are readily soluble in water.

Aimaline, unlike reserpine, does not have neuroleptic activity, moderately lowers blood pressure, somewhat enhances coronary blood flow, has a negative inotropic effect and a moderate adrenolytic effect.

Aymaline is characterized by its antiarrhythmic properties. It lowers the excitability of the myocardium, lengthens the refractory period, inhibits atrioventricular and intraventricular conduction, somewhat inhibits the automatism of the sinus node, suppresses impulse formation in ectopic foci of automatism.

Aimaline is an effective remedy for relieving attacks of atrial fibrillation and paroxysmal tachycardia. It is also effective for rhythm disturbances associated with intoxication with digitalis drugs.

The drug is administered intravenously, intramuscularly and orally; it is especially effective when administered parenterally.

For relief of acute attacks of atrial fibrillation and paroxysmal tachycardia, 0.05 g (2 ml of a 2.5% solution) is injected intravenously in 10 ml of isotonic sodium chloride solution or 5% glucose solution. Enter slowly - within 3-5 minutes. If necessary, you can re-enter another 0.05 g during the day. You can inject the drug drip: 2-4 ml of a 2.5% solution in 100-200 ml of isotonic sodium chloride solution. Intramuscularly, 0.05 g (2 ml of a 2.5% solution) is injected every 8 hours up to 0.15 g / day (i.e., up to 3 times). If necessary, the drug is administered for several days in a row.

When a therapeutic effect is achieved from parenteral administration, they switch to taking the drug orally, 1-2 tablets (0.05-0.1 g) 3-4 times a day (for 1-3 weeks). Aimaline is generally well tolerated. Some patients have hypotension, general weakness, nausea, vomiting; with intravenous administration - a feeling of heat.

Aymaline contraindications (especially for intravenous administration): severe lesions of the cardiac conduction system, pronounced sclerotic and inflammatory changes in the myocardium, stage III circulatory failure, severe hypotension. Caution is necessary in the case of the administration of aymaline to patients with a recent myocardial infarction: a decrease in blood pressure and conduction disturbances are possible.

Aymalin is produced in tablets of 0.05 g, in ampoules of 2 ml of a 2.5% solution (25 mg in 1 ml). Store the drug on list B in a dark place.

Part of preparations

C.02.A.A.04 Sum of rauwolfia alkaloids

IX.I10-I15.I10 Essential [primary] hypertension

Nature is so wisely arranged that it has everything that a person needs to live happily ever after. Even plants are endowed with special properties to avoid or prevent diseases. For example, snake rauwolfia, which contains more than 25 alkaloids, is able to stabilize blood pressure. People have known about this for a long time and used its roots to treat hypertension.

Description of rauwolfia snakes

It is an evergreen shrub with a tap root up to 3 m in length. It has a non-fibrous structure and gives large lateral roots. Although it has a narrow brown bark, the inside of the root is light, odorless and bitter in taste.

Leaves are located from three or more pieces on one node; rauwolfia serpentine with a regular distribution is less common. They have a dense, smooth and shiny structure, predominantly oval in shape with a short petiole.

The flowers of this plant are collected in inflorescences - apical or umbellate, white or pink. The rim of a tubular five-bladed structure, the blades of which are superimposed one on top of the other. Black rauwolfia fruits, drupe-like with juicy pulp, accrete to the middle.

The snake rauwolfia, the description of which is presented in the article, got its name due to the fact that in India it was used in the case of the bites of these reptiles. In every peasant hut, several bushes of this plant always grew.

Growing environment

Today, rauwolfia is cultivated in some countries, but in the wild it has long been found in parts of India such as the tropical regions of the Himalayas, in Central and North Bengal, and Sikkim. Today it can be found in Sumatra, Peru, Sri Lanka, Myanmar and Java. Rauwolfia snake is cultivated in Georgia.

At one time, the healers and shamans of Asia actively used its roots to heal not only people, but also animals. The main use is for snake and insect bites, for fever, cholera, diarrhea, for children, as a mild sleeping pill, and in Java it was used as an anthelmintic.

Chemical composition

The roots of rauwolfia serpentine are valuable, since they contain 2% alkaloids, including:

• reserpine: the main property is blockade of adrenergic neurons;
• aymaline has antiarrhythmic properties;
• yohimbine improves blood circulation, increases physical activity;
• papaverine has antispasmodic properties;
• sarpagin lowers blood pressure;
• thebaine is a poisonous substance.

These are far from all alkaloids found in the roots of the plant. According to some reports, their number ranges from 25 to 50 species. Leaves and stems are rich in flavonoids, carotenoids and milky sap. Reserpine is the main alkaloid of rauwolfia serpentine, which is used in medicine and homeopathy.

In many ways, the place of growth of this plant and the time of collection are directly related to the amount of alkaloids in its roots. For example, if the plant was harvested in December in the Indian state of Assam, then their percentage will be 2.57, which is a record in comparison with other habitats. At the same time, the age of the plant has nothing to do with these indicators.

Application in medicine

Scientists only in the 20th century were able to properly study and evaluate the pharmacological properties of this plant. They revealed:

• Reserpine affects the peripheral nervous system. At the same time, the heart rate in the human body slows down without changing the minute volume of the heart. Reserpine has the property of gradually lowering blood pressure in any form and stage of development of hypertension. Its positive effect on lipid and protein metabolism was also noted.
• Raunatin is most effective at the 1st and 2nd stages of the development of hypertension.
• The property of aymaline is a calm decrease in pressure without surges and sudden drops. It has a negative effect, that is, it reduces the force of contraction of the heart, at which the excitability of the myocardium decreases.

Preparations containing alkaloids of rauwolfia serpentine are widely used in medicine today. When scientists in the 20th century were able to isolate reserpine from it and tested its effect in animals, and then in a clinical setting in humans, it became possible to produce drugs based on it. This even today relieves patients with hypertensive crises and makes life easier.

Application in traditional medicine

It is not known how Asian peoples in ancient times found out that snake rauwolfia can be useful and for what diseases, but there is evidence that even hunters used it. They anointed her with the juice of arrows and spears so that they became deadly, and thus killed the animals.

In folk medicine, it is used:

• In the early stages of hypertension, but subject to dosage. Only by consuming 1-1.5 g of uvar 3 times a day for two weeks will the first result be obtained. The course can be extended for another 2 weeks and the dose can be increased by another 1 gram if there is no allergic reaction. A complete cure can be achieved in 3-4 months. If there are any side effects, then the treatment can be suspended for a month, and then continued again until complete recovery.

• For mental disorders, a few drops of dichloteazide tincture should be added to the rauwolfia decoction.
• For gastrointestinal diseases, the leaves of the plant are used. It is enough to take 1 tbsp. l. leaves, pour 1 tbsp. boiling water, insist, and then grind the mixture into a gruel and leave for another 4 hours. Strain the mass and divide into 4 daily portions.
• For insomnia, both bark and leaves are used in equal proportions. Take 25 g of the mixture, pour 1 tbsp. water and boil in a water bath to half a glass. After that, add boiled water to the previous level and drink 75 g before bedtime until a positive result.
• With a rapid heart rate, 100 g of water is 20 g of rauwolfia serpentine root. Pour the root with water, bring to a boil and let it boil for 1-2 minutes, then pour the hot broth into a thermos and leave overnight. Strain the finished broth and drink 1 tbsp. l. before meals for a month.

Rauwolfia serpentine, whose use is widely known in medicine and homeopathy, should only be used under the direction and supervision of a physician. This is due to the fact that it can be poisonous if the dosage is not followed.

Procurement of raw materials

Since the need for alkaloids that make up the roots of rauwolfia serpentine is very high in the world, it is specially grown on plantations. The cultivated plant is suitable for use at the age of 3-4 years. When it is in the fruiting stage, it is dug up along with the root, which is carefully cut along with all the roots and cleaned of dirt, trying not to damage the bark, which contains the largest amount of alkaloids.

If the bark is somehow damaged, then such a product is considered defective and cannot be further processed. Rauwolfia snake is cut into pieces and left to dry in the sun or in specially made ventilated rooms using dryers at a temperature of + 50-60 degrees.

Reserpine therapy

This drug is one of the oldest and most proven drugs in antihypertensive therapy. It is used by clinics and research institutes all over the world. Over the 60-year practice of studying the properties of the snake rauwolfia, scientists have identified:

Thus, snake rauwolfia, preparations from which ("Raunatin", "Kristepin", "Brinerdin") can be bought at any pharmacy, remains in demand, despite the fact that new drugs for hypertensive patients appear every year. Apparently, 60 years of positive results is enough time to trust her.

Side effects

If the dosage is observed, then there were no side effects in drugs with rauwolfia snakes. In case of its violation, there may be such manifestations:

• skin rash;
• increased blood flow in the mucous membranes of the eyes;
• stomach cramps and pain;
• weakness and dizziness;
• dyspnea;
• nausea with vomiting;
• nightmares.

In some cases, during the course of treatment, insomnia, anxiety and depression may appear. If these symptoms appear, you should immediately stop taking the drug and consult a doctor to adjust the dosage.

The history of the study of rauwolfia snakes

While in India this plant has been used for centuries to treat snakebites, as a sleeping pill for children, to relieve spasms and lower blood pressure, in Europe they became interested only in the 30s of the 20th century. The first alkaloid was isolated in 1931, then the discoveries of its new properties followed one after another.

For example, in Germany, they began to conduct research not only on pharmaceutical preparations from rauwolfia serpentine, but also on its individual components, checking their properties one by one and in combination with each other.

Varieties of rauwolfia

In the world, not only snake rauwolfia is known (see photo below), but also its varieties, which also have pharmaceutical properties.

For example:

• rauwolfia vomit grows in the forests of the Congo;
• rauwolfia gray-haired native to Australia, India and South America;

Without exception, all varieties of this plant are used for the needs of pharmaceutical companies.

Rauwolfia snake(serpentine) of the kutrovy family (Apocynaceae).

Chemical composition. The roots and rhizomes of the plant contain from 1 to 2% alkaloids, which are derivatives of indole. Among them are reserpine, aymalin, aymalicin, isoaymaline, isorauchimbine, yohimbine, papaverine, rauwolfinin, rauchimbine, reserpenin, reserpiline, rescinamine, sarpagin, serpentine, serpentinine, serpine, thebaine, chaindnejca alloids, and others. Cora contains 90% of the total. roots. In other parts of the plant, the content of these alkaloids is an order of magnitude lower. Their content also depends on the place of growth of the plant and the time of procurement of medicinal raw materials. It has been established that the highest concentration of active substances occurs in the winter season. The plant also contains starch, resin, sterol.

In addition to alkaloids (the content, as noted, in these parts is low), the leaves and stems of the plant also contain carotenoids, flavonoids, and milky juice (rubber).

All of these active ingredients form the basis of the chemical composition of the serpentine rauwolfia (serpentines).

Medicines."Reserpine" (tablets) and its preparations: "Adelfan", "Adelfan-esidrex", "Triresid", "Brinerdin"; "Aymalin" (tablets, ampoules). "Raunatin" (tablets) contains the sum of the alkaloids of rauwolfia roots.

Application. The drugs are used to lower blood pressure in hypertension and mental disorders (reserpine). "Raunatin" acts milder than reserpine - as an antihypertensive and antiarrhythmic agent "Aymalin" is an effective remedy for arresting attacks of atrial fibrillation.

Reserpine (Resserpinum). Initially, before the advent of modern antipsychotics, reserpine was used to treat mental illness. Currently, reserpine is rarely used as an antipsychotic agent; it is mainly used as an antihypertensive agent for the treatment of arterial hypertension. Prescribed more often in combination with other antihypertensive drugs (diuretics, etc.). Assign reserpine orally in the form of tablets (after meals). Doses and duration of treatment are selected individually.

In case of arterial hypertension in the early stages, reserpine is usually prescribed at 0.05-0.1 mg 2-3 times a day. In some cases, it is enough to continue using the drug at these doses, in others, the dose is gradually increased. Usually, in order to avoid depression, a daily dose of 0.5 mg is limited, but with good tolerance, it is increased to 1 mg. If the hypotensive effect does not occur within 10-14 days, the drug is canceled.

Upon reaching the effect, the dose is gradually reduced to 0.5-0.2-0.1 mg per day. Treatment with small (maintenance) doses is carried out for a long time (courses of 2-3 months, if necessary 3-4 times a year) under the supervision of a physician.

Reserpine is also used for mild forms of heart failure with tachycardia (together with cardiac glycosides), hypersympathicotonia, and late toxicosis of pregnant women. In case of thyrotoxicosis, reserpine is prescribed together with thyrostatic substances. Reserpine itself does not have a thyrostatic effect, but it reduces neurovegetative disorders and causes a decrease in the pulse rate. The use of reserpine can reduce the dose of antithyroid drugs.

In psychiatric and neurological practice, reserpine is prescribed mainly for neuropsychiatric disorders based on high blood pressure, as well as for persistent insomnia and other diseases. In the treatment of schizophrenia, reserpine is sometimes used in combination with other antipsychotics. Reserpine is also recommended for the treatment of alcoholic psychoses.

Higher doses for adults inside: single 0.002 g (2 mg), daily 0.01 g (10 mg). For mental illness, reserpine is taken orally on the first day from 0.25 to 2 mg, then the dose is increased to 10-15 mg per day. For neuroses, it is prescribed in small doses, starting from 0.25 mg 2-3 times a day to 0.5 mg 3-4 times a day. For children, reserpine is prescribed in a dose of 0.1 to 0.4 mg per day (in 2-4 doses), depending on age.

In small doses, reserpine, as a rule, does not cause side effects. At high doses and increased sensitivity, there may be hyperemia of the mucous membranes of the eyes, skin rash, stomach pain, diarrhea, bradycardia, weakness, dizziness, shortness of breath, nausea, vomiting, nightmares. With prolonged use, parkinsonism is possible. During the course of treatment, patients with mental illness may develop feelings of anxiety, anxiety, persistent insomnia, and a state of depression. In patients with bronchial obstruction, reserpine can cause an acute attack of bronchospasm. Bronchospasm is treated with atropine.

Contraindications: severe organic cardiovascular diseases with symptoms of decompensation and severe bradycardia, nephrosclerosis, cerebral sclerosis, gastric ulcer and duodenal ulcer.

Reserpine is part of a number of combined drugs used in hypertension.

Adelfan (Аdelphan) - tablets containing reserpine 0.0001 g (0.1 mg) and dihydralazine 0.01 g (10 mg). Dihydralazine, which is similar in structure and action to apressin, is a peripheral vasodilator. Applied for hypertension, 1-2 tablets 3 times a day (after meals).

Adelfan-esidrex (Adelphan-Esidrex) contains reserpine O, 1 mg, dihydralazine 10 mg and dichlothiazide 10 mg, and adelfan-esidrex-K (Adelphan-Esidrex K) - reserpine 0.1 mg, dihydralizine 10 mg, hydrochlorothiazide 10 mg potassium chloride 0.6 g and one tablet. The addition of potassium chloride is calculated to prevent possible hypokalemia from the use of hydrochlorothiazide. Prescribe 1 / 2-1 tablet 1-2-3 times a day.

Brinerdin (Brinerdin) - dragees containing reserpine 0.0001 g (0.1 mg), dihydroergocristine 0.0005 g (0.5 mg), clopamide (brinaldix) 0.005 g (5 mg). Dihydroergocristine is a peripheral and central adrenergic blocking agent; clopamide is a saluretic. Used for hypertension and symptomatic hypertension. It is taken orally 1 tablet from 1 to 3 times a day (depending on the nature of the disease and the patient's condition). The course of treatment is from 10 days to several months.

Christepine (Crusterin) - dragees containing 0.1 mg of reserpine, 0.5 mg of dihydroergocristine and 5 mg of the diuretic clopamide. It is used for various forms of arterial hypertension. It is taken starting with 1 tablet a day, then increasing the dose as needed to 2-3 tablets a day in 2-3 doses. Maintenance dose - 1 tablet a day or every other day.

Triresid (Triresid) - tablets of composition: reserpine 0.1 mg, dihydralazine sulfate (see Apressin) 10 mg and hydrochlorothiazide 10 mg. Triresid is also available with an additional content of 0.35 g of potassium chloride in each tablet. Indications for the use of trireside are the same as for cristepine, etc.

When taking all of these tablets (except those containing potassium chloride), patients should be advised to eat foods rich in potassium. Potassium should be monitored.

Raunatin (Rаunatinum) - a preparation containing the sum of alkaloids from the roots of rauwolfia snakes or other types of raufolfia. The main indication for the use of raunatin is hypertension, especially in stages I and II. In psychiatric practice, raunatin is not widely used due to an insufficiently pronounced neuroleptic effect, but it can be used for neurotic conditions.

Assign orally in tablets. Usually start with taking 1 tablet containing 0.002 g (2 mg) of the amount of alkaloids at night; on the 2nd day, take 1 tablet 2 times a day, on the 3rd day - 3 tablets and bring the total dose to 4-5-6 tablets per day; take the drug after meals. After the onset of the therapeutic effect (usually after 10-14 days), the dose is gradually reduced to 1-2 tablets per day. The course of treatment usually lasts 3-4 weeks, but sometimes the drug is taken for a long time in a maintenance dose (1 tablet per day). Treatment should be carried out under the supervision of a physician. Simultaneously with raunatin (or sequentially), you can prescribe other antihypertensive drugs, ganglion blocking drugs, apressin, dichlothiazide, etc.

Raunatin usually does not cause side effects. Some patients tolerate it better than reserpine. In some cases, there is swelling of the nasal mucosa, sweating, general weakness; in patients with angina pectoris, pain in the region of the heart sometimes increases. Side effects disappear when the dose is reduced or after a short (1-3 days) break in taking the drug.

Ajmalin (Ajmalinum) (unlike reserpine, also contained in rauwolfia) does not have neuroleptic activity, moderately lowers blood pressure, slightly increases coronary blood flow, has a negative ionotropic effect and a moderate adrenolytic effect.

Aymaline is characterized by its antiarrhythmic properties. It lowers the excitability of the myocardium, lengthens the refractory period, inhibits atrioventricular and intraventricular conduction, somewhat inhibits the automatism of the sinus node, suppresses impulse formation in ectopic foci of automatism. Refers to group I antiarrhythmic drugs.

Aimalin is able to stop attacks of atrial fibrillation and paroxysmal tachycardia. It is also effective for rhythm disturbances associated with intoxication with digitalis drugs.

Assign intravenously, intramuscularly and inside; more effective when administered parenterally.

For the relief of acute attacks of atrial fibrillation and paroxysmal tachycardia, 0.05 g (2 ml of a 2.5% solution) is injected intravenously in 10 ml of isotonic sodium chloride solution or 5% glucose solution. Enter slowly - within 7-10 minutes. If necessary, during the day, you can re-enter another 0.05 g. You can enter the drug dropwise: 2-4 ml of a 2.5% solution in 100-200 ml of isotonic sodium chloride solution.

Intramuscularly, 0.05 g (2 ml of a 2.5% solution) is injected every 8 hours up to 0.15 g per day (that is, up to 3 times). If necessary, the drug is administered for several days in a row.

When a therapeutic effect is achieved from parenteral administration, they switch to taking the drug orally, 1-2 tablets (0.05-0.1 g) 3-4 times a day (within 1-3 weeks).

Aimaline is generally well tolerated. Some patients have hypotension, general weakness, nausea, vomiting; with intravenous administration - a feeling of heat.

Contraindications(especially for intravenous administration): severe lesions of the cardiac conduction system, pronounced sclerotic and inflammatory changes in the myocardium, III degree circulatory failure, severe hypotension. Caution is necessary when administering aymaline to patients with fresh myocardial infarction: a decrease in blood pressure and conduction disturbances are possible.

Mushroom drier(Gnaphalium uliginosum L.). Fam. aster - Asteracea. Other names: marsh creeper, toad.

Chemical composition. Flavonoids (trioxydimethoxyflavone, gnaphaloside A and B), at least 0.2% carotene, up to 4% tannins, essential oil, up to 16% resins, ascorbic acid, phytosterol alkaloids.

The aboveground part during the budding phase contains: ash - 25.64%; macroelements (mg / g): K - 28.40, Ca - 7.60, Mn - 2.70, Fe - 1.00; trace elements (CBN): Mg - 0.73, Cu -7.72, Zn - 0.51, Co - 2.11, Mo - 48.00, Cr - 0.18, Al - 0.70, Ba - 0 , 52, V - 0.18, Se - 6.70, Ni - 0.22, Sr - 0.06, Pb - 0.08, Br - 152.70. B - 117.00 - mcg / g. Not found Cd, Li, Ag, Au, I. Concentrates Fe, Mo, Cu, Co, Se, Al. The aboveground part during the flowering phase contains: ash - 17.08%; macroelements (mg / g): K - 49.90, Ca - 15.70, Mn - 2.90, Fe - 2.30; microelements (CBN): Mg - 0.37, Cu - 3.65, Zn - 2.00, Co - 0.65, Mo - 6.60, Cr - 0.90, Al - 0.93, Ba - 0 , 60, V - 0.53, Se - 4.50, Ni - 0.38, Sr - 0.25, Cd - 50.00, Pb - 0.23, Br - 4.80, Li - 18.00 ... B - 60.00 mcg / g. Not found Au, Ag, I. Concentrates Fe, Cu, Zn, Mo, Al, Se, Cd, especially Cu, Fe, Zn. Can accumulate Mg.

Application. The grass creeper is used for hypertension in the form of an infusion (10.0: 200.0 or 20.0: 200.0) 1 / 2-1 / 3 cup 3 times a day. The best results were observed in the treatment of patients with hyperkinetic type of blood circulation.

The infusion is also used in the complex treatment of hypertensive patients taking β-blockers, to mitigate the action of the latter, to remove orthostatic reactions, as well as sharp fluctuations in blood pressure. A positive selective effect of infusions on cerebral hemodynamics was noted even with a small general hypotensive effect.

In case of gastric ulcer and duodenal ulcer, gastritis, the infusion of creeper (1 tablespoon 3-4 times a day before meals) is prescribed, as a rule, in combination with other plants. In case of gastric ulcer with high acidity, a vitamin-oxygen cocktail is used in hospitals, consisting of rose hips (50 g), motherwort herb (15 g), calamus root (15 g), marsh cinnamon herb (15 g), St. John's wort ( 15 g), mint leaves (15 g), water (1.5 L); sugar syrup is added to taste. An infusion is prepared from the plants, 1 tablespoon is used for the procedure.

The shrimp is indicated for acute and chronic enteritis, colitis, bacterial and amoebic dysentery. In the complex therapy, a 5% infusion of creeper is used, 1 tablespoon 3 times a day, 20-30 minutes before meals.

For post-dysenteric dysfunctions, proctogenic constipation, tenesmus, hemorrhoids, the infusion of dried cinnamon is used in the form of medicinal enemas. One hour after the cleansing enema, at night, 100 ml of 5% warm infusion of dried cumin is injected into the rectum daily or every other day. 5-6 procedures are recommended.

In case of erysipelas, a medicinal collection is used, including the herb of dryweed and yarrow, nettle and eucalyptus leaves, calamus roots, burnet and licorice. Plants are taken equally. The infusion is prepared in a ratio of 1:10 and 1:20. Assign 20-50 ml 4 times a day for 7-10 days. Inside, the infusion of creeper is prescribed for thrombophlebitis. In the form of foot baths, the infusion of creeper is used for phlebothrombosis, thrombophlebitis, endarteritis, trophic ulcers of the lower extremities. To prepare a bath, 100 g of dried grass herb is poured into 5 liters of boiling water, insisted for 30-40 minutes. Baths are done at night, the water temperature is 35-37 ° C, the duration is 15-20 minutes.

Outwardly, the dried herb is used in the form of an infusion or an alcohol-oil extract, which is used to lubricate difficult-to-heal wounds, ulcers, and burns. The infusion of creeper is prescribed for rinsing with stomatitis, toothache, ulcers in the mouth, with tonsillitis and chronic tonsillitis.

Local infusion baths are used for excessive sweating of the legs and palms.

Contraindications and side effects. This medicinal plant is not recommended for all those people who have been noted to be hypersensitive to any of the components that make up its composition. Most often, this plant is perceived by the human body quite well. In very rare cases, against the background of its use, various allergic reactions can make themselves felt.

Contraindicated in bradycardia. It should not be used for a long course with hypotension, vegetative-vascular dystonia of the hypotonic type.

Hypersensitivity to the drug, arterial hypotension, increased blood clotting, thrombophlebitis, cholelithiasis, pregnancy, breastfeeding, age up to 18 years.

Periwinkle(burial ground) - Vinca minor L. Kutrovy family - Apocynaceae.

Other plant names: burial ground, coffin-grass, ivy, brilliant green, flower, vinca.

Chemical composition... The herb and leaves of periwinkle contain indole alkaloids (minorin, vincamine, vinine, pubiscin), flavonoids, bitter substances, ascorbic acid, carotene and other compounds.

All these active ingredients form the basis of the chemical composition of the periwinkle (burial ground).

Application... The plant periwinkle has been used since the days of ancient medicine as a sedative, reducing dizziness and headache, and lowering blood pressure.

Preparations. Vincapan and devinkan have a vasodilator (mainly on the vessels of the brain), hypotensive and mild sedative effect.

They are used for hypertension, cerebrovascular spasms, neurogenic tachycardia and other autonomic neuroses. The antihypertensive effect of the drugs is especially pronounced in patients with hypertension stage I-II, less than stage III. Preparations of periwinkle small have a positive effect on the work of the heart, increase the resistance of capillaries, increase daily urine output. They are of low toxicity. The effect of periwinkle treatment lasts up to 3 months. The preparations of periwinkle are close to the preparations of rauwolfia. Devinkan is also effective for migraines.

Infusion of periwinkle small, in addition, is used as a hemostatic (for uterine, intestinal bleeding), astringent and antimicrobial agent. Small periwinkle is widely used in folk medicine in many countries as an astringent, hemostatic and wound healing agent; it is used for hemorrhages from various organs, diarrhea, fever, malaria and in other cases. A decoction of the herb is used externally for compresses for weeping eczema, rashes, itching, for rinsing with toothache and inflammation in the mouth.

Dosage forms, method of administration and dosage drugs... Effective drugs and forms are made from the herb and leaves of periwinkle, which are used in the treatment of many diseases. Let's consider the main ones.

Infusion of small periwinkle herb. Method for preparing infusion from periwinkle herb: 5 g (1 tablespoon) of crushed leaves of a plant are poured in 200 ml (1 glass) of boiling water, boiled in a water bath for 15 minutes, cooled, filtered, squeezed out the remaining raw materials. Take the infusion during the day (for hypertensive patients) 1/3 cup 3 times a day.

Vincapan (Vincapanum) is a preparation containing the amount of vinca alkaloids. Assign inside 0.005-0.01 g 2-3 times a day, the dose for children is set depending on age. Vincapan is produced in tablets of 0.01 g.

Devincan is a methyl ester of tartaric acid. Has a vasodilator and hypotensive effect, gives a weak sedative effect. The drug acts mainly on the blood vessels of the brain, improving the blood supply to the brain tissue. In this regard, it is used mainly in the cerebral form of hypertension, including crises. Devinkan is also prescribed with a systemic increase in blood pressure (in stages I and II of hypertension) and with neurogenic tachycardia.

Devinkan is administered orally and intramuscularly. Inside, adults are given 0.005-0.01 g (5-10 mg), starting from 2-3 times a day, and then 3-4 times a day. Children are prescribed 0.0025-0.005 g (2.5-5 mg) 2-3 times a day. Devinkan treatment is usually continued for several weeks; before the end of treatment, gradually reduce the dose. Intramuscular injections of the drug are made only in a hospital setting; injected, starting with a dose of 0.005 g (1 ml of 0.5% solution), once a day; then 1-2 ml 2 times a day. After improving the condition, they switch to taking pills.

Devinkan is produced in tablets containing 0.005 and 0.01 g (5-10 mg), and in ampoules containing 0.005 g (5 mg) of the drug.

Rauwolfia snake -Rauwolfia serpentina Benth.

Sem. kutrovye - Apocynaceae

Botanical characteristics. An evergreen shrub containing milky sap, 0.2-0.6 (1) m high. It has a small vertical rhizome with numerous adventitious roots and a long tap root with large lateral roots. The stem is ascending, covered with a whitish cork. The leaves are arranged whorled in 3-4, less often opposite or alternate, oblong-elliptical, obovate or obovate or obovate, pointed at the apex, narrowed at the base into a short petiole, thin, glabrous, shiny, 7.5-17.5 cm long. The flowers are white or pink, collected in apical, less often axillary, dense umbellate inflorescences. The calyx and pedicels are bright red. The fruit consists of two juicy red drupes (Fig. 10.31).

Rice. 10.31. Rauwolfia snake -Rauwolfia serpentina Benth.

Spreading. Naturally occurs in India, Thailand, Burma, Sri Lanka and Indonesia. Cultivated in India. Raw materials are currently being imported to Russia.

Habitat. Grows on the edges of tropical rainforests.

Blank. In places of natural growth, the roots are harvested in the fruiting phase in plants with a well-developed root system. On plantations in India, roots are dug up in the third or fourth year of the plant's life.

External signs. Pieces of roots, cylindrical or split longitudinally, covered with brown cork. The outer surface is longitudinally wrinkled. The break is even. Yellow wood is visible on the break. The bark is not wide, but alkaloids are localized in it, therefore the presence of pieces of roots with exfoliated bark is a defect in raw materials. The smell is characteristic, unpleasant. Taste is not determined (!).

Microscopy. The cork has a characteristic layering - layers of larger and smaller cells alternate. The phloem contains single secretory cells with brown resinous contents. In the cells of the parenchyma, starch grains are quite often found, less often - prismatic crystals of calcium oxalate. The bark lacks mechanical elements (unlike the roots of other rauwolfia species).

Chemical composition. The roots contain a total of 1–2% of indole alkaloids. Currently, more than 50 alkaloids have been isolated (reserpine, aymaline, serpentine, rescinamine, yohimbine, etc.).

Storage. The raw materials are stored according to the B.

Medicines.

1. Raunatin, po tablets 0.002 g each (the sum of alkaloids). Antihypertensive, antiarrhythmic, sedative.

2. Reserpine, tablets of 0.0001 and 0.00025 g. Antihypertensive, sedative.

3. Aymalin, tablets of 0.05 g; solution for injection 2.5%. Antiarrhythmic agent.

4. Reserpine is a part of complex preparations ("Brinerdin", "Trirezid K", "Adelfan-Ezidreks", "Kristepin", etc.).

Pharmacotherapeutic group. Antihypertensive, sedative, antiarrhythmic agent.

Pharmacological properties. Rauwolfia alkaloids have various pharmacological properties. They mainly affect the central nervous system, reserpine and, to a lesser extent, rescinamine have a sedative and hypotensive effect, yohimbine - alpha-adrenergic blocking, aymalin - antiarrhythmic action. The main pharmacological property of reserpine is its sympatholytic effect due to the depletion of norepinephrine resources in adrenergic nerve endings. Reserpine has a complex effect on the body. Its antihypertensive effect is largely associated with the effect on the peripheral nervous system, and neuroleptic effect on the central neurochemical processes. Under the influence of reserpine, systolic and diastolic pressure gradually decreases in different forms and stages of hypertension. The best effect is observed in the early stages of hypertension, in the absence of pronounced organic changes in the cardiovascular system. The antihypertensive effect persists for a relatively long time after discontinuation of reserpine. Along with a decrease in blood pressure, renal function improves: renal blood flow increases, glomerular filtration increases. There is evidence of a positive effect of reserpine on lipid and protein metabolism in patients with essential hypertension and coronary atherosclerosis. Aimaline has no neuroleptic activity, moderately lowers blood pressure. Aymaline is characterized by its antiarrhythmic properties.

Application. The raw materials are used to obtain the preparations "Reserpine", "Aimalin", which are pure alkaloids, and the total preparation "Raunatin". "Reserpine" is used to lower blood pressure in hypertension and mental disorders. "Raunatin" has a milder hypotensive and sedative effect, it also has antiarrhythmic and antispasmodic properties. "Aymalin" is an effective remedy for the relief of atrial fibrillation attacks. Reserpine is part of a number of combined drugs used in hypertension.

Other types. Rauwolfia vomitoria Afz., Which grows in tropical Africa from the west coast to Mozambique, r. four-leafed (r. grayish) (R. tetraphylla L. = R. canescens L.), widespread in South America, India, Australia, as well as r. kaffra (R. caffra Soud.), growing in Africa. The first two types are promising for introduction into industrial culture in the Transcaucasus. At the St. Petersburg Chemical-Pharmaceutical Academy, a microcloning technology has been proposed for their breeding, and a method for obtaining biomass of a tissue culture, which is a source of aymaline, has been developed and implemented.