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From the Townsend Letter
May 2015

Rauwolfia in the Treatment of Hypertension
by Douglas Lobay, Bsc, ND
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My Experience with Rauwolfia
I have been practicing naturopathic medicine for 21 years and have tried many different herbal and mineral supplement combinations to treat hypertension. I have used rauwolfia and reserpine products alone or in combination with herbs and minerals. I currently prefer rauwolfia combined with hawthorn and some form of magnesium. I have used capsules, tablets, and tinctures, and find that I prefer encapsulated rauwolfia root powder. I have prescribed over 80,000 capsules of rauwolfia to over 300 patients with hypertension. I do not prescribe over 500 milligrams of rauwolfia per day, and usually only prescribe the equivalent of 100 milligrams of rauwolfia twice per day. Some patients I prescribe 300 to 400 milligrams per day if needed.
I support the concept of low-dose rauwolfia; the results have been amazing. I consistently see sustained blood pressure drops in most patients with hypertension. A systolic drop of 20 to 30 millimeters and a diastolic drop of 10 to 15 millimeters are normal. I have observed rauwolfia consistently work as well as other first-line antihypertensive drugs. I have combined rauwolfia with other antihypertensive medicines. It combines well with diuretics and ACE inhibitors and ARB blockers. Caution should be exercised when the patient is on a beta blocker or calcium channel blocker. Most patients report that they feel better and less anxious and nervous. Sleep quality often improves.
I have not seen many adverse side effects. Occasional nasal congestion and loose stools have been reported. I have not seen any cases of depression. I screen all patients for history of depression and mental illness and evaluate whether they would benefit from rauwolfia therapy. I do not prescribe rauwolfia to patients who say they are depressed. Nor do I give rauwolfia to patients with congestive heart failure or cardiac decompensation, especially weak, frail elderly patients. I do not prescribe rauwolfia to patients with bradycardia or heartbeat less than 60 beats per minute. I have observed rauwolfia to lower pulse rates, usually by about 10 beats per minute in some patients. I figure that these patients may not benefit from adrenergic blockade. The potential adverse risks could potentially outweigh the benefit. I do not prescribe rauwolfia to patients who show symptoms of hypoadrenalism unless they have higher blood pressure, faster pulse, and symptoms of nervous anxiety.
As a rule, I do not prescribe rauwolfia to patients on prescription medicines for depression, including SSRIs, SNRIs, NDRIs, and tricyclic antidepressants. Logic dictates that there is conflict with giving rauwolfia to patients who are on drugs whose goal is to raise norepinephrine, serotonin, and other catecholamines. I also do not prescribe rauwolfia to patients on natural medicines whose goal is to raise these neurotransmitters. These natural medicines include 5-hydroxytryptophan; tyrosine; St. John's wort; and other herbal medicines that might increase norepinephrine, serotonin, or other circulating catecholamines. Although these drugs and natural medicines work on different mechanisms, it is still a contraindication to give rauwolfia with other medicines whose goal is to have the opposite effect. Exercise caution and good clinical judgment when dealing with patients who might be on these drugs and natural medicines.
I am happy and confident in my use of rauwolfia in the treatment of hypertension. In my experience, I have observed rauwolfia to be the single best natural remedy for high blood pressure.

Based on a review of the literature, rauwolfia appears to be a safe and effective treatment for hypertension when used in appropriate low doses. An equivalent dose of pure rauwolfia alkaloids, also known as alseroxylon extract or pure reserpine, can also be used to treat hypertension. LDR (low-dose rauwolfia) can be safely recommended to patients who have been screened to benefit from this treatment. The total daily dose of rauwolfia should be less than 500 milligrams of root and in most cases can be less than 250 milligrams per day. The purified alkaloid alseroxylon extract would be less than 5 milligrams per day and in most cases less than 2.5 milligrams per day. The reserpine dose would be less than 500 micrograms per day and in most cases less than 250 micrograms per day. An equivalent tincture dose would be based on the strength of the tincture. For instance, the dose of a 1:5 tincture would be 0.5 milliliters equalling 100 milligrams of crude root. In a standard dropper, 15 drops would equal 1.0 milliliters.

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Douglas Lobay, Bsc, ND
103B-1980 Cooper Road,
Kelowna, BC, Canada, V1Y 8K5

Douglas LobayDouglas G. Lobay is a practicing naturopathic physician in Kelowna, British Columbia. Dr. Lobay graduated with a bachelor of science degree from the University of British Columbia in 1987. He then attended Bastyr College of Health Sciences in Seattle, Washington, and graduated with a doctorate of naturopathic medicine in 1991. While attending Bastyr College, he began research the scientific information on the use of food, nutrition, and natural healing. Dr. Lobay enjoys research, writing, and teaching others about good health and good nutrition. He is the author of four books and numerous articles in magazines. He also enjoys hockey, skiing, hiking, tennis, and playing guitar.

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