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Open Access 01-12-2017 | High Impact Review in Neuroscience, Neurology or Psychiatry - Review Article

Evidence-based treatment of neurogenic orthostatic hypotension and related symptoms

Authors: Sabine Eschlböck, Gregor Wenning, Alessandra Fanciulli

Published in: Journal of Neural Transmission | Issue 12/2017

Abstract

Neurogenic orthostatic hypotension, postprandial hypotension and exercise-induced hypotension are common features of cardiovascular autonomic failure. Despite the serious impact on patient’s quality of life, evidence-based guidelines for non-pharmacological and pharmacological management are lacking at present. Here, we provide a systematic review of the literature on therapeutic options for neurogenic orthostatic hypotension and related symptoms with evidence-based recommendations according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Patient’s education and non-pharmacological measures remain essential, with strong recommendation for use of abdominal binders. Based on quality of evidence and safety issues, midodrine and droxidopa reach a strong recommendation level for pharmacological treatment of neurogenic orthostatic hypotension. In selected cases, a range of alternative agents can be considered (fludrocortisone, pyridostigmine, yohimbine, atomoxetine, fluoxetine, ergot alkaloids, ephedrine, phenylpropanolamine, octreotide, indomethacin, ibuprofen, caffeine, methylphenidate and desmopressin), though recommendation strength is weak and quality of evidence is low (atomoxetine, octreotide) or very low (fludrocortisone, pyridostigmine, yohimbine, fluoxetine, ergot alkaloids, ephedrine, phenylpropanolamine, indomethacin, ibuprofen, caffeine, methylphenidate and desmopressin). In case of severe postprandial hypotension, acarbose and octreotide are recommended (strong recommendation, moderate level of evidence). Alternatively, voglibose or caffeine, for which a weak recommendation is available, may be useful.

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Title: Evidence-based treatment of neurogenic orthostatic hypotension and related symptoms
Authors: Sabine Eschlböck
Gregor Wenning
Alessandra Fanciulli
Publication date: 01-12-2017
Publisher: Springer Vienna
Published in: Journal of Neural Transmission / Issue 12/2017
Print ISSN: 0300-9564
Electronic ISSN: 1435-1463
DOI: https://doi.org/10.1007/s00702-017-1791-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evidence-based treatment of neurogenic orthostatic hypotension and related symptoms

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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