Sunday, September 19, 2010

Treatment of orthostatic hypotension in Parkinson's disease

Source: Neurology 2009 supplement cited above, p.S83
1. Consider a role for medication, including selegeline, levodopa, DA agonists and MAO inhibitors.
2.  Increase sodium intake, especially in daytime.
3.  Avoid lying flat which leads to release of renin. Elevate HOB and legs.
4.  Postprandial hypotension can be avoided with small meals, with low carbohydrate intake and avoiding alcohol
5.  Caffeine with breakfast can be helpful
6.  Heat related vasodilatation, vasovagal activities (straining at stool, playing wind instruments, singing all can be considered/limited if applicable.
7.  Isometric exercise especially swimming
8.  Avoid knee high TEDS, consider waist high Jobst stockings or abdominal binders.
1. Florinef up to 0.5 (start with 0.1 mg).
2. DDAVP 5-40 ug intranasally at bedtime can be tried.  Monitor Na+ in first 4-5 days of treatment and monthly thereafter.  It can cause a severe and life threatening hyponatremia.
3.  Midodrine, start at 2.5 mg per day, do not go above 10 tid, and do not give at bedtime.
4. Erythropoietin 4,000 units biw especially if anemic also.
5.  End of dose sweating can be an "off" phenomenon and can eb treated with more dopamine.

No comments: