Mestinon for OH

Singer et al. Pyridostigmine treatment trial in neurogenic orthostatic hypothension. Arch Neurol 2006; 63:513-518.

Pyridostigmine may improve OH especially diastolic BP without affecting systolic BP due to effect on efferent limb of baroreflex in a 2 neuron system synapsing at the autonomic ganglion.

Study was a 4 way crossover study at Mayo Clinic in MN on 56 patients. Finding was that alone or with low dose midodrine alleviates OH without exacerbating HTN