Elderly pt

[Ama2007]

would you use midodrine for the treatment of orthostatic hypotension in an old patient on alot of other drugs..there is not much evidence for the use of hydrocortisone or pyridostigmine (according to cochrane) in OH so I thought midodrine would be the best choice...

Any ideas??

has anyone come across this before (old patient with OH)

is there any standard drugs you can use??


Thanks

[Nik]

Never heard of midodrine before - quick google search suggests it acts similarly to other alpha and beta adrenoceptor agonists, eg adrenaline, ephedrine. Just an educated guess but I wouldn't have thought hydrocortisone would be an appopriate choice considering the glucocorticoid effects which would be produced (ie side effects) whereas the mineralocorticoid effects would be desirable. It hasn't got much mineralocorticoid effect whereas fludrocortisone may be more appropriate. Again this is only a bit of logical thinking but if the postural hypo was caused by adrenal insufficiency then hydrocortisone and fludrocortisone together would treat the primary cause. As you've mentioned this (hypothetical ?) patient is on a number of other drugs, the postural hypo could be drug induced, in which case it could be managed.

[Ama2007]

sorry, I meant fludrocotisone,
its not drug induced, she is diabetic and had a stroke recently, so i thought it could be diabetic neuropathy but im not too sure...

[Nik]

Well that changes everything - BNF has a little bit of info on neuropathic postural hypo. Fludrocortisone is mentioned for unlicensed use but midodrine appears to be an unlicensed drug. Presumably if they are a diabetic they must be on anti-hypertensives, which could cause postural hypo ? Never come across midodrine so I presume most docs use fludrocortisone.

[johnep]

I sometimes feel dizzy and treat by just bending over. Usually then check BP and lower than usual. I always cautioned pts when starting BP meds not to get up too quickly during first few days.
johnep