Orthostatic Intolerance Medication

Updated: Nov 13, 2019
  • Author: Julian M Stewart, MD, PhD; more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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Alpha/Beta Agonists

Class Summary

These agents improve the hemodynamic status by increasing myocardial contractility and heart rate, resulting in increased cardiac output. They also increase peripheral resistance by causing vasoconstriction. Increased cardiac output and increased peripheral resistance lead to increased blood pressure.

Droxidopa (Northera)

Droxidopa is a synthetic amino acid analog directly metabolized to norepinephrine by dopadecarboxylase. Increases blood pressure by inducing peripheral arterial and venous constriction.

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Corticosteroids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

Fludrocortisone

Fludrocortisone may increase blood volume by promoting salt and water retention.

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Colony Stimulating Factors

Class Summary

These agents are hormones that stimulate the production of red cells from the erythroid tissues in the bone marrow.

Epoetin alfa (Procrit, Epogen)

Purified glycoprotein produced from mammalian cells modified with gene coding for human erythropoietin (EPO). Amino acid sequence is identical to that of endogenous EPO. Biological activity mimics human urinary EPO, which stimulates division and differentiation of committed erythroid progenitor cells and induces release of reticulocytes from bone marrow into the blood stream. By increasing red blood cell mass it may increase blood volume.

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Anticholinesterase Inhibitors

Class Summary

These agents raise the concentration of acetylcholine, by inhibiting the degradation of Ach, at the myoneural junction and increase the chance of activating the acetylcholine receptor.

Pyridostigmine bromide (Mestinon)

Pyridostigmine bromide acts in smooth muscle, CNS, and secretory glands where it blocks the action of ACh at parasympathetic sites. It may enhance autonomic activity.

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Alpha 1 Agonists

Class Summary

These drugs are used to treat orthostatic hypotension that is refractory to nonpharmacologic recommendations.

Midodrine

Midodrine is a selective alpha1-adrenergic agonist used for the treatment of hypotension.

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