Neurogenic orthostatic hypotension induced by tizanidine

Farrell, Maureen C.; Biaggioni, Italo; Shibao, Cyndya A.

doi:10.1007/s10286-019-00637-5

Cited by 7 publications

(4 citation statements)

References 4 publications

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“…101 Tizanidine, commonly prescribed in the United States as a central muscle relaxant, is a central sympatholytic related to clonidine that can induce a clinical picture of neurogenic OH with abnormal cardiovascular reflexes, especially among those taking strong CYP1A2 inhibitors. 102,103 "Uroselective" α-1a receptor antagonists (eg, tamsulosin) that preferentially relax the smooth muscle in the bladder and urethra are commonly prescribed for benign prostatic hyperplasia and are known to increase the incidence of severe OH, requiring hospital admissions. 104 It is also important to consider the severity of the patient's autonomic impairment.…”

Section: Practical Steps To Manage Oh In Adults With Hypertensionmentioning

confidence: 99%

Orthostatic Hypotension in Adults With Hypertension: A Scientific Statement From the American Heart Association

Juraschek,

Cortez,

Flack

et al. 2024

Hypertension

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Although orthostatic hypotension (OH) has long been recognized as a manifestation of autonomic dysfunction, a growing body of literature has identified OH as a common comorbidity of hypertension. This connection is complex, related to pathophysiology in blood pressure regulation and the manner by which OH is derived as the difference between 2 blood pressure measurements. While traditional therapeutic approaches to OH among patients with neurodegenerative disorders focus on increasing upright blood pressure to prevent cerebral hypoperfusion, the management of OH among patients with hypertension is more nuanced; resting hypertension is itself associated with adverse outcomes among these patients. Although there is substantial evidence that intensive blood pressure treatment does not cause OH in the majority of patients with essential hypertension, some classes of antihypertensive agents may unmask OH in patients with an underlying autonomic impairment. Practical steps to manage OH among adults with hypertension start with (1) a thorough characterization of its patterns, triggers, and cause; (2) review and removal of aggravating factors (often pharmacological agents not related to hypertension treatment); (3) optimization of an antihypertensive regimen; and (4) adoption of a tailored treatment strategy that avoids exacerbating hypertension. These strategies include countermaneuvers and short-acting vasoactive agents (midodrine, droxidopa). Ultimately, further research is needed on the epidemiology of OH, the impact of hypertension treatment on OH, approaches to the screening and diagnosis of OH, and OH treatment among adults with hypertension to improve the care of these patients and their complex blood pressure pathophysiology.

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Section: Practical Steps To Manage Oh In Adults With Hypertensionmentioning

confidence: 99%

Orthostatic Hypotension in Adults With Hypertension: A Scientific Statement From the American Heart Association

Juraschek,

Cortez,

Flack

et al. 2024

Hypertension

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“…After 12 hours, the orthostatic hypotension resolved and the patient admitted to inappropriate use of tizanidine. 14 Bradycardia. Two records reported bradycardia associated with oral tizanidine use.…”

Section: Tizanidinementioning

confidence: 99%

“…6,11 Tizanidine stimulates these receptors in the brainstem, which reduces sympathetic outflow from the CNS, thus decreasing systemic vascular resistance and heart rate. 11,14 Cortes et al 11 described a patient who experienced severe bradycardia and hypotension, requiring multiple interven tions. This patient was also taking diltiazem and metopro lol, which can both cause bradycardia.…”

Section: Baclofenmentioning

confidence: 99%

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Baclofen and Tizanidine Adverse Effects Observed Among Community-Dwelling Adults Above the Age of 50 Years: A Systematic Review

Killam-Worrall,

Brand,

Castro

et al. 2023

Ann Pharmacother

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Objective: This review highlights adverse effects of baclofen and tizanidine in older community-dwelling adults. Data Sources: A literature search was conducted, including search terms of “adverse effect,” “baclofen,” “elderly,” “falls,” “fractures,” and “tizanidine.” Studies were included if they described community-dwelling adults aged 50 years and older who received oral baclofen or tizanidine. The Federal Drug Administration Adverse Event Reporting System (FAERS) data were compiled for adverse effect incidence. Study Selection and Data Extraction: The literature search was completed in July 2019 and updated in June 2023. Reviews performed by 2 independent reviewers yielded 15 records. FAERS identified 486 (baclofen) and 305 (tizanidine) adverse effects of interest. Data Synthesis: Two retrospective cohort studies evaluating baclofen use in older adults showed increased hospitalizations for encephalopathy in chronic kidney disease (7.2% vs 0.1%) and end-stage renal disease (daily dose 20 mg or more; relative risk [RR] 19.8, 95% CI = [14.0-28.0]). Other articles were case reports; 10 articles reported dyskinesias, encephalopathy or disorientation, and drowsiness associated with baclofen, and 5 articles reported bradycardia and/or hypotension with tizanidine. The FAERS Public Dashboard revealed 12.1% and 28.7% overall incidence of adverse effects of interest, with a 27.8% and 29.2% incidence of falls for baclofen and tizanidine, respectively. Baclofen and tizanidine are associated with concerning adverse effects in older adults. Alternative agents should be considered, but, if necessary, providers should start at lower doses and increase slowly. Conclusions: This review highlights the importance of using baclofen and tizanidine with caution in older adults.

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Bioanalytical Comparison of Transdermal Delivery of Tizanidine from Different Nanovesicular Carriers

et al. 2020

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Neurogenic orthostatic hypotension induced by tizanidine

Cited by 7 publications

References 4 publications

Orthostatic Hypotension in Adults With Hypertension: A Scientific Statement From the American Heart Association

Orthostatic Hypotension in Adults With Hypertension: A Scientific Statement From the American Heart Association

Baclofen and Tizanidine Adverse Effects Observed Among Community-Dwelling Adults Above the Age of 50 Years: A Systematic Review

Bioanalytical Comparison of Transdermal Delivery of Tizanidine from Different Nanovesicular Carriers

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