Rauwolfiae radix

Rauwolfiae radix, also known as Rauwolfia root, is a drug monographed by Commission E, made from the whole or cut dried root of Rauwolfia srepentina, the snakewood. Rauwolfiae radix is used as a herbal medicine for the treatment of mild hypertension.

Commission E-monograph: Mild, essential hypertension (borderline hypertension), especially with increased sympathetic tone, sinus tachycardia, anxiety and states of tension and psychomotor agitation, if dietary measures are not sufficient. Due to the central side effects of reserpine, hardly used today and obsolete as a neuroleptic.

ESCOP: not processed

HMPC: not processed

Rauwolfia root contains 1 to 2 % indole alkaloids such as:

• reserpine
• rescinamine
• deserpine
• ajmaline
• raubasin
• serpentine.

According to the DAB , the drug must have a total alkaloid value (calculated as reserpine, the active ingredient) of at least 1 %. The Rauwolfia alkaloids are classified according to their structure and basicity as follows:

• quaternary anhydronium bases (serpentine, serpentinine and alstonine)
• tertiary indoline alkaloids (ajmaline, rauwolfinine and semperflorine)
• tertiary indole bases(reserpine, yohimbine, ajmaciline, reserpinine)

Remark: The diversity of the Rauwolfia alkaloids is explained by the occurrence of numerous stereoisomers.

Rauwolfia root reduces the effect of the sympathetic nervous system in the body, lowers blood pressure and has a sedative effect.

Rauwolfiae radix is used to treat mild hypertension, especially when it is accompanied by increased sympathetic tone. For example, in states of tension, anxiety, psychomotor agitation and sinus tachycardia.

The average daily dose of the drug (crushed drug with precisely adjusted alkaloid content!) is 600 mg (corresponding to 6 mg of total alkaloids - ).

In rare cases it can lead to depressive moods, fatigue, potency disorders or a blocked nose.

In case of existing depression, ventriculopathy and duodenal ulcer, phaechromocytoma, or during pregnancy or lactation, the patient should refrain from taking it.

If digitalisglycosides are taken at the same time, bradycardia may occur. In combination with neuroleptics and barbiturates, the effects may be mutually reinforcing.

The simultaneous intake of levodopa leads on the one hand to a weakening of the effect, but can also lead to an intensification of undesirable extrapyrmidal motor symptoms. A combination with sympathomimetics can lead to a considerable increase in blood pressure initially.

Only homeopathic Rauwolfia preparations are still commercially available. For patients who explicitly insist on a herbal antihypertensive, a doctor's prescription must be issued.

Ajmaline is available as Gilurytmal® 50 mg/10 ml solution for injection - indication cardiac arrhythmia.

Taking Rauwolfia can lead to an impairment of the ability to react and thus to the fitness to drive.
Preparations containing Rauwolfiae radix are available only on prescription.

1. Schilcher H (2016) In: Leitfaden Phytotherapie, Urban & Fischer Verlag Munich, p. 262
2. Wiesenauer M (2008) PhytoPraxis. Springer Medizin Verlag Heidelberg, pp. 165-166.
3. https://www.awl.ch/heilpflanzen/rauvolfia_serpentina/schlangenwurzel.htm

4. Blaschek W (2015) Wichtl-Teedrogens and phytopharmaceuticals. A handbook for practice. Wissenschaftliche Verlagsgesellschaft Munich. S 543-545