Fludrocortisone for orthostatic hypotension

Veazie, Stephanie; Peterson, Kim; Ansari, Yasmin; Chung, Kathryn A.; Gibbons, Christopher H.; Raj, Satish R.; Helfand, Mark

doi:10.1002/14651858.cd012868

Cited by 2 publications

(3 citation statements)

References 33 publications

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“…Drugs generally recommended for OH treatment are fludrocortisone and/or midodrine, with due consideration of their precautions. There are systematic reviews currently underway that will hopefully provide more robust evidence. Meanwhile, it is important to tailor treatment based on individual presentation and needs.…”

Section: Resultsmentioning

confidence: 99%

Review of management strategies for orthostatic hypotension in older people

Godbole

Aggarwal

2018

Pharmacy Practice and Res

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Orthostatic hypotension (OH) is common in older people and is associated with a range of adverse outcomes. Although agerelated changes like decreased baroreflex sensitivity make older people prone to OH, medications are often a contributor. Diagnosis of OH can be challenging in older people, because the condition may present with atypical or non-specific symptoms, such as visual disturbances, shortness of breath, mental fluctuation. Non-pharmacological management is often a starting point for OH treatment. Fludrocortisone and midodrine remain the most studied drugs for pharmacological management, but newer agents are being tested. In this review we present the current evidence for existing and emerging treatments for OH and address the management of supine hypertension associated with the treatment of OH in patients with autonomic failure. In the management of OH, it is imperative that treatment is tailored to the individual, rather than focusing on attaining an arbitrary blood pressure target.

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Section: Resultsmentioning

confidence: 99%

Review of management strategies for orthostatic hypotension in older people

Godbole

Aggarwal

2018

Pharmacy Practice and Res

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“…Moreover, there are no available studies to evaluate fludrocortisone specifically for treatment of IDH. A recent Cochrane review found that fludrocortisone was evaluated in 13 crossover and observational studies for treatment of orthostatic hypotension in patients with diabetes and Parkinson disease [11]. The authors of the latter review concluded that available evidence was very uncertain about the effects of fludrocortisone on blood pressure, orthostatic symptoms or adverse effects in these 2 diseases [11].…”

Section: Use Of Fludrocortisone For Treatment Of Intradialytic Hypotensionmentioning

confidence: 99%

“…Hypokalemia is dose-related and occurs early within few days of administration, persists with long-term use of fludrocortisone, and frequently require potassium supplementation and high potassium diet [12]. Other adverse effects reported are headache insomnia and increase sweating [11]. Since adverse effects increase with the dose, it is reasonable to start fludrocortisone with 0.1 mg qday, then increase the dose after few days to 0.2 mg qday if no blood pressure response was seen similar to the strategy applied in our patient.…”

Section: Safety Profile Of Fludrocortisonementioning

confidence: 99%

Fludrocortisone for Treatment of Intradialytic Hypotension: Case Report and Review of Literature

Mikhail¹

2021

IJCEMR

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Background: Intradialytic hypotension (IDH) is a common complication of hemodialysis (HD). Pharmacologic treatment options are limited in terms of number and efficacy. Objective: To report a case of IDH that responded to fludrocortisone. Similar cases and pertinent literature were reviewed. Methods: Pubmed research of English literature up to June 16, 2021. Search terms included, hemodialysis, hypotension, intradialytic hypotension, midodrine, fludrocortisone, droxidopa, safety, efficacy. Retrospective studies, case report and series, Cochrane reviews, randomized trials are reviewed. Results: Midodrine and droxidopa are approved by the Federal Drug Administration (FDA) for treatment of orthostatic hypotension, but not for IDH. No randomized trials are available to evaluate midodrine for IDH. One large retrospective study suggests that midodrine use for treatment of IDH may be associated with increase death and hospitalization. Results of a single randomized phase 2 trial suggest that droxidopa may not be effective in IDH. The author reports a 63-year-old patient with IDH who failed midodrine but responded to the addition of fludrocortisone. Review of literature revealed 3 other similar cases, No short-term adverse effects of fludrocortisone were reported in any of these 4 cases. Conclusions: Pharmacological options available for treatment of IDH are limited and inadequately studied. Fludrocortisone appears a promising agent to prevent IDH in patients failing midodrine. Randomized trials are needed to compare efficacy and safety of midodrine and fludrocortisone and their combination for management of IDH.

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Fludrocortisone for orthostatic hypotension

Cited by 2 publications

References 33 publications

Review of management strategies for orthostatic hypotension in older people

Review of management strategies for orthostatic hypotension in older people

Fludrocortisone for Treatment of Intradialytic Hypotension: Case Report and Review of Literature

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