Ask Dr KK
(Dr KK Aggarwal, Group Editor in
Chief, IJCP Group of Publications and eMedinews)
Dear Dr Aggarwal, Namaskar. Please give me
some information about postural hypotension. Is it more common in patients with
Parkinson’s disease? How is this condition treated? Vinod Agrahari
Yes, postural hypotension is common in Parkinson disease. A
proper lifestyle is the only answer. One must get up slowly and in stages from
the lying down position. If this fails, then there are some drugs that may
help.
The initial treatment of orthostatic hypotension should focus on non drug measures: removal of offending medications, using elastic stockings, physical maneuvers and exercise. If drugs are required one must follow step-wise treatment using fludrocortisone for patients with disabling symptoms despite non drug measures, followed by a sympathomimetic pressor agent, such as midodrine, for patients who remain symptomatic on or cannot tolerate fludrocortisone. Several other modalities (as mentioned below) may be beneficial
1. Caffeine in the morning may help.
2. A trial with recombinant erythropoietin can help in patients with anemia.
3. Nonsteroidal antiinflammatory drugs may be useful in those with refractory symptoms
The initial treatment of orthostatic hypotension should focus on non drug measures: removal of offending medications, using elastic stockings, physical maneuvers and exercise. If drugs are required one must follow step-wise treatment using fludrocortisone for patients with disabling symptoms despite non drug measures, followed by a sympathomimetic pressor agent, such as midodrine, for patients who remain symptomatic on or cannot tolerate fludrocortisone. Several other modalities (as mentioned below) may be beneficial
1. Caffeine in the morning may help.
2. A trial with recombinant erythropoietin can help in patients with anemia.
3. Nonsteroidal antiinflammatory drugs may be useful in those with refractory symptoms
Parkinson's pt is prescribed syndopa, 4% of it reacdes in brain & 96% is metabolised in periphey to dopamine, which causes postural hypotention.Pt took care while standing from sitting posture.Further dose modification of syndopa may help.My wife suffered for 15 yrs from Parrinsonism, & I being Pharmacologist, may be of some help in dosage management.
ReplyDeleteDr.A.K.KELA,Former Director Prof & h.o.d,L.H.M.C.,New Delhi