Rauwolfia Plant: What It Does, and Why Doctors Stopped Using It

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If you’ve come across rauwolfia while researching natural options for blood pressure or anxiety, here’s the short version: it’s not a fringe herbal claim. The rauwolfia plant produced reserpine, one of the first real pharmaceutical treatments for high blood pressure, back in the 1950s. That’s unusual — most “traditional remedy” plants never produce an actual prescription drug.

But that also means rauwolfia comes with something most herbs don’t: decades of clinical data, including a well-documented depression risk, and a 2024 update confirming that reserpine is no longer sold in the United States at all. This article covers what’s actually known, not just what’s traditionally claimed.

What is the rauwolfia plant?

Rauwolfia serpentina — also called Indian snakeroot — is a shrub native to South and Southeast Asia, historically used to treat snake bites, insomnia, high blood pressure, and mental illness [Britannica]. Its root has been used for centuries in Ayurvedic and other Indian medical traditions long before Western science took an interest in it. (If insomnia is what brought you here, our guide to 5 Foods That Help You Sleep covers gentler, better-evidenced options.)

That interest arrived in 1952, when researchers isolated the plant’s most important compound, reserpine, which was subsequently used to treat hypertension [Britannica]. Reserpine became one of the first modern antihypertensive drugs and was, for a time, also used as an antipsychotic — a genuine pharmacological success story from an herbal source, which is part of why rauwolfia still shows up in supplement form today.

What’s actually in it — and what reserpine does in the body

The rauwolfia root contains a large family of related compounds called indole alkaloids — researchers profiling root, leaf, and callus samples have identified several dozen of them, with reserpine consistently the most abundant and most studied [Alkaloid Profiling, 2011].

A separate compound in the plant, ajmaline, has documented anti-arrhythmic activity and is still used clinically in some countries as a heart-rhythm medication and diagnostic tool — a different use case from reserpine’s blood pressure effect. Rauwolfia is one of many plants historically classified as acting on the nervous system; see our roundup of Discover 59 Herbs for the Nervous System for how it compares to gentler options.

Reserpine’s mechanism is well understood: it depletes norepinephrine, serotonin, and dopamine from nerve terminals, which lowers blood pressure but also explains its psychiatric side effects [ScienceDirect — unverified]. This same mechanism is part of why reserpine became historically important to neuroscience — its depressive side effect contributed to the “monoamine hypothesis” of depression.

What the evidence says about blood pressure

The strongest evidence for rauwolfia’s blood-pressure effect comes from its purified compound, reserpine, not the raw root. A 2016 update of a Cochrane systematic review found that reserpine, used alone, was effective in reducing systolic blood pressure to roughly the same degree as other first-line antihypertensive drugs [Cochrane Database of Systematic Reviews, 2016]. That’s a real finding — but the same review flagged its limits clearly: the trials involved small sample sizes, didn’t test a wide range of doses, and didn’t report enough data to properly evaluate side effects.

In practical terms: reserpine worked, but the evidence base is old, thin, and doesn’t tell us much about optimal dosing or long-term safety by modern standards. A more recent proof-of-concept study also found reserpine could meaningfully lower blood pressure in patients whose hypertension hadn’t responded to five or more other medications — but this was a small study in a narrow, treatment-resistant population, not evidence for general use (StatPearls/NCBI Bookshelf).

If you’re weighing rauwolfia against other plant-based options, our Best Herbs for High Blood Pressure guide compares the evidence across the field — and rauwolfia’s evidence, while real, comes with a heavier safety trade-off than most of what’s covered there.

Reserpine was originally a first-line hypertension treatment, later downgraded to a second-line option as newer drugs with better side-effect profiles arrived. Then, in 2024, MedlinePlus confirmed that reserpine is no longer available in the United States at all, and that anyone still taking it should talk to their doctor about switching to another treatment [MedlinePlus, 2024]. The branded versions — Serpasil, Serpalan, and several combination products — have all been discontinued, with generics also unavailable.

That’s the central fact this plant’s modern story turns on: it isn’t that reserpine doesn’t work. It’s that it was replaced by drugs that work about as well with a better safety margin — and now it isn’t a mainstream medical option in the U.S. at all.

The depression warning — and why it’s more complicated than it sounds

Reserpine’s link to depression is one of the most-cited facts about this plant, and it deserves a careful explanation rather than a flat warning.

The concern dates to the 1950s, when physicians treating hypertension with high-dose reserpine began reporting psychiatric complications — sadness, fatigue, and in some cases suicidal ideation — that resolved when the drug was stopped [Journal of Psychopharmacology, 2022]. That’s a real, historically important finding, and it’s why reserpine carries a caution around depression to this day.

But a comprehensive 2022 systematic review of 35 studies on reserpine and depression found a genuinely mixed picture, not a settled one: 11 studies reported some depression-related effect, 13 found no effect, and 11 actually reported apparent antidepressant effects — usually in studies using higher doses for shorter periods [Journal of Psychopharmacology, 2022]. The review’s authors noted most of these studies carried a high risk of bias by modern standards, and concluded the relationship needs more nuance than a simple cause-and-effect story allows.

None of that erases the warning — depression, including thoughts of suicide, is listed as a “call your doctor immediately” side effect on reserpine’s official U.S. drug information [MedlinePlus, 2024]. It just means the science is more complicated than “this drug causes depression,” and mood symptoms during use are a real, worth-taking-seriously signal, not a myth.

There’s a similar story with an old breast-cancer concern: several 1974 studies suggested a possible link between rauwolfia-type drugs and breast cancer, prompting real alarm at the time. Larger follow-up studies over the next decade — including a major U.S. retirement-community study and multiple European case-control studies — mostly failed to confirm a meaningful increased risk, and some found no association at all. It’s a good example of an early signal that didn’t hold up under further research.

Because reserpine’s history is so tied up with psychiatric medicine — it was one of the first drugs used to treat schizophrenia — it’s worth understanding the broader picture of how mood and psychotic disorders are diagnosed and treated today. Our overview of Mental Health Disorders is a useful starting point if any of this section feels personally relevant.

Other side effects and interactions

Beyond mood effects, reserpine’s documented side effects include:

• Drowsiness, dizziness, and fatigue
• Nausea, diarrhea, and stomach upset
• Slowed heart rate (bradycardia) and, less commonly, fainting or chest pain
• Stuffy nose and dry mouth
• Decreased sexual ability [MedlinePlus, 2024]

Because reserpine depletes the same neurotransmitters targeted by several other drug classes, it has clinically significant interactions. It’s contraindicated with deutetrabenazine (used for movement disorders), and it can increase sedation when combined with other CNS depressants [Medscape — unverified]. If you’re taking any prescription medication — especially antidepressants, other blood pressure drugs, or anything sedating — this isn’t a supplement to add without your prescriber knowing about it.

Who shouldn’t use it — pregnancy, breastfeeding, and other cautions

Reserpine and rauwolfia carry several relative and absolute cautions:

• History of depression or suicidal ideation — a relative contraindication
• Active peptic ulcer or ulcerative colitis — reserpine can increase gastric acid secretion
• Recent or planned electroconvulsive therapy — should not be combined with reserpine

Pregnancy and breastfeeding — MedlinePlus advises telling your doctor immediately if you’re pregnant, planning pregnancy, or breastfeeding while taking reserpine [MedlinePlus, 2024]. Separately, a 2025 Philippines FDA advisory flagged Rauvolfia serpentina supplements for illegal promotion as an abortifacient, citing the plant’s history of use as a uterine stimulant in some traditional practices [Philippines FDA, 2025].

• Older adults — MedlinePlus specifically notes people 65+ should discuss risks and benefits carefully, since high doses aren’t as well tolerated.

How it’s used today

In the U.S., reserpine as a standalone prescription drug is gone. What remains are raw rauwolfia root powder and extract products sold as dietary supplements, plus homeopathic preparations. Neither is FDA-approved for treating any condition, and neither has been evaluated by the FDA for safety or effectiveness the way a drug would be.

We’re not going to give you a specific milligram dose for root powder here. Here’s why: reserpine itself is dosed in micrograms — as low as 20 mcg per day, up to a maximum around 0.25 mg (250 mcg) per day in its purified pharmaceutical form (StatPearls/NCBI Bookshelf) — while raw root powder contains reserpine at a much lower, less predictable concentration alongside dozens of other alkaloids.

One secondary pharmacology reference puts typical rauwolfia supplement dosing around 600 mg of root material (roughly equivalent to 6 mg of reserpine), but we couldn’t independently verify that figure against a primary source, so treat it as a rough historical reference point, not a target [ScienceDirect — unverified]. Given how narrow reserpine’s safe range is, and how much potency varies between plant sources and preparation methods, self-dosing raw rauwolfia isn’t something you should do without a doctor involved.

HEALTH DISCLAIMER: Rauwolfia and its main compound, reserpine, are not gentle “try it and see” herbs. Reserpine has a documented depression risk, can slow your heart rate, interacts with several medication classes, and the purified drug is no longer even sold in the United States. This article is for general education and isn’t a substitute for medical advice. Talk to your doctor before using any rauwolfia product — especially if you’re pregnant or breastfeeding, have a history of depression, take other medications, or have a stomach, heart, or mood condition. If you’re currently taking prescription reserpine and aren’t sure why it’s unavailable, contact your doctor about switching treatments rather than stopping abruptly.

Frequently Asked Questions

References

1. Encyclopaedia Britannica. Rauvolfia serpentina. View source
2. Shamon SD, Perez MI. Blood pressure-lowering efficacy of reserpine for primary hypertension. Cochrane Database of Systematic Reviews. 2016;12:CD007655. PMID: 27997978. View source 
3. StatPearls/NCBI Bookshelf. Reserpine (Archived). NBK557767. View source 
4. MedlinePlus (National Library of Medicine). Reserpine. Last revised June 20, 2024. View source
5. Systematic review of reserpine and depression. Journal of Psychopharmacology, 2022. PMC10076328. View source 
6. ScienceDirect Topics. Rauwolfia Alkaloid overview chapter. View source
7. Philippines Food and Drug Administration. FDA Advisory No. 2025-1552. View source 
8. Kumar A, et al. Alkaloid Profiling and Estimation of Reserpine in Rauwolfia serpentina. Asian Journal of Plant Sciences, 2011. View source
9. Medscape Drug Interaction Checker — reserpine. View source 
10. Lancet / NEJM / European Journal of Clinical Pharmacology — reserpine and breast cancer studies, 1974–1984 (multiple). Representative: View source