Carotid Sinus Hypersensitivity Medication

Updated: Nov 15, 2018
  • Author: Mevan N Wijetunga, MD, FACC, FHRS; Chief Editor: Mikhael F El-Chami, MD  more...
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Medication Summary

Although a variety of pharmacological agents has been used empirically to treat recurrent, symptomatic CSH, no single agent has been unequivocally proven to provide long-term effectiveness in large-scale, randomized controlled trials. Some observers have successfully used the serotonin reuptake inhibitors sertraline and fluoxetine in patients who were unresponsive to dual-chamber pacing.

A randomized, controlled pilot study showed that treatment with midodrine, an alpha-1 agonist, could significantly decrease the rate of symptoms and the degree of hypotension in the vasodepressor form of CSH. Treatment with midodrine was also associated with an elevation of a mean 24-hour ambulatory blood pressure level. [25] Midodrine induces arterial and venous capacitance constriction and has minimal cerebral and cardiac effects. It is indicated for the treatment of symptomatic orthostatic hypotension.

Fludrocortisone is another agent that can be used in this setting.

The US Food and Drug Administration has not yet approved these agents for the management of CSH.