Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
Copyright © 2017 by The Korean Balance Society. All rights reserved.
This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Medication | |
Diuretics | Thiazide, furosemide, acetazolamide, spironolactone |
Vasodilators | Amlodipine, nifedipine, hydralazine, alpha-1 antagonist (terazosin, alfuzosin, doxazosin, prazosin, tamsulosin), minoxidil |
Anti-depressants | Tricyclic antidepressants (amitriptyline, nortriptyline, imipramine, desipramine) |
Dopaminergic agents | Levodopa, ropinirole, pramipexole |
Beta-blockers | Propranolol, metoprolol, atenolol, bisoprolol (also vasodilator), nebivolol, carvediolol (also alpha-1 antagonist), labetalol (also alpha-1 antagonist) |
Others | Nitroprusside, sildenafil, clonidine |
Clinical states | |
Hypovolemia | Dehydration, bleeding |
Impaired cardiac output | Heart failure, cardiac arrhythmia, aortic stenosis |
Venous pooling | Fever |
Study design | Year | Participants | Intervention/comparison | Follow-up | Level of evidence |
---|---|---|---|---|---|
Midodrine [29] | |||||
RCT, parallel [25] | 1993 | 97 Adults with symptomatic OH and history or syncope or near syncope | Midodrine 2.5, 5, 10 mg tid/placebo | 4 wk | B/10 mg midodrine tid 4 wk: standing SBP drop↑, OH Sx.↑ |
RCT, parallel [26] | 1997 | 171 Adults with symptomatic OH | Midodrine 10 mg tid/placebo | 6 wk | B/10 mg midodrine tid 2 wk: standing SBP drop↑, OH Sx.↑ |
RCT, crossover [27] | 1998 | 25 Adults with symptomatic OH | Midodrine 2.5, 10, 20 mg qd/placebo | 6 day | B/10 mg midodrine: standing SBP drop↑ |
Pyridostigmine | |||||
Open label [30] | 2003 | 15 Adults with neurogenic OH | Pyridostigmine 60 mg | 1 hr | C/standing SBP, DBP drop↑, OH Sx.↑ |
RCT, crossover [31] | 2006 | 58 Adults with neurogenic OH | Pyridostigmine 60 mg with and without 2.5, 5 mg midodrine/placebo | 6 hr | B/60 mg pyridostigmine ±5 mg midodrine: standing DBP drop↑ |
RCT, crossover [32] | 2010 | 31 Adults with neurogenic OH | Pyridostigmine 60 mg; yohimbine 5.4 mg/placebo | 1 hr | B/60 mg pyridostigmine: standing DBP drop→ |
RCT, crossover [33] | 2017 | 9 Parkinson disease patients with OH | Fludrocortisone 0.2 mg qd; pyridostigmine 60 mg tid | 2 wk | B/pyridostigmine 60 mg tid 2 wk standing DBP drop→ |
Fludrocortisone | |||||
RCT, crossover [34] | 1975 | 5 Adults with symptomatic OH | Fludrocortisone 0.1 mg bid/placebo | 3 wk | B/fludrocortisone 0.1 mg bid 3 wk: standing SBP, DBP drop↑ |
RCT, crossover [35] | 2007 | 13 Parkinson disease with symptomatic OH | Fludrocortisone 0.1 mg; domperidone 10 mg/nonpharmacologic therapy | 3 wk | B/fludrocortisone 0.1 mg qd 3 wk: autonomic Sx.↑ |
RCT, crossover [33] | 2017 | 9 Parkinson disease patients with OH | Fludrocortisone 0.2 mg qd; pyridostigmine 60 mg tid | 2 wk | B/fludrocortisone 0.2 mg qd 2 wk: standing SBP drop↑ |
RCT, randomized controlled trial; OH, orthostatic hypotension; tid, 3 times a day; SBP, systolic blood pressure; ↑, improved; Sx., symptom; qd, once a day; DBP, diastolic blood pressure; →, no change; bid, 2 times a day. Level of evidence A, data derived from multiple randomized clinical trials or meta-analyses of such studies; B, data derived from one or more randomized or non-randomized trials or meta-analysis of such studies; C, non-randomized observational studies with limitation in design or consensus opinion of experts based on clinical experience.