Pharmacology of orthostatic hypotension in Parkinson’s disease: from pathophysiology to management
Authors: Pathak, Atul; Senard, Jean-Michel
Source: Expert Review of Cardiovascular Therapy, Volume 2, Number 3, May 2004 , pp. 393-403(11)
Publisher: Expert Reviews
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Abstract:
Orthostatic hypotension is highly prevalent in the elderly, and affects up to 20% of patients with Parkinson’s disease. Pharmacological approaches help to demonstrate that Parkinson’s disease is a primary autonomic failure with involvement of the peripheral autonomic nervous system as shown by decreased [123I] meta-iodobenzylguanidine cardiac uptake and preserved growth hormone response to clonidine. No specific clinical trial has evaluated efficacy of antihypotensive drugs in Parkinson’s disease. End point of treatment should be a reduction in postural symptoms. Midodrine (Proamatin®, Roberts Pharmaceutical), a vasoconstrictor and fludrocortisone (Florinef®, Bristol–Myers Squibb), a volume expander are first choice drugs. No data are available on their effects on orthostatic hypotension-related morbidity. The usefulness of other drugs remains to be demonstrated. This review will highlight the importance of nonpharmacological measures in the management of orthostatic hypotension in Parkinson’s disease.Keywords: fludrocortisone; midodrine; nonpharmacological measures; orthostatic hypotension; peripheral autonomic failure
Document Type: Research article
DOI: 10.1586/14779072.2.3.393
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