Ambulatory norepinephrine treatment of severe autonomic orthostatic hypotension

Oldenburg, Olaf; Mitchell, Anna; Nürnberger, Jens; Koeppen, Susanne; Erbel, Raimund; Philipp, Thomas; Kribben, Andreas

doi:10.1016/s0735-1097(00)01062-7

Cited by 39 publications

(12 citation statements)

References 21 publications

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“…After losing the initial beneficial effects of midodrine and fludrocortisone treatment in this patient, we immediately proposed the NE pump infusions given the severity of the symptoms; other drugs such as subcutaneous octreotide, yohimbine, droxidopa, or domperidone may also be considered before proceeding to invasive management as in our patient [1]. This report confirms the results of Oldenburg's study describing six patients successfully treated with the NE pump infusions in which none of them suffered complications due to arterial hypo-or hypertension, or infection of the infusion system [4]. Multi-disciplinary (neurologist/nephrologist/internist/ pharmacologist), expert evaluation, neuro-hormonal assessment data, and blood pressure monitoring are helpful in coping with PAF and assessing the best treatment options, including NE constant infusions.…”

Section: Discussionsupporting

confidence: 76%

“…However, in 2001 he presented with progressive worsening of his condition, he was not able to stand up, and eventually he was unable to leave the home. At this time a NE infusion with a portable pump was proposed in the literature and we decided to use it for this patient, after explaining the advantages and the possible risks of that procedure and obtaining his consent during an interdisciplinary meeting [4].…”

Section: Case Reportmentioning

confidence: 99%

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Successful long-term ambulatory norepinephrine infusions in a patient with pure autonomic failure

et al. 2015

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We present a case study of a patient with pure autonomic failure who was successfully treated with ambulatory norepinephrine (NE) infusions over a 9-year-period of time before death occurred unexpectedly. Given this patient's response to the NE infusion treatment, we discuss the option of ambulatory NE infusions as a treatment for severe orthostatic hypotension that is refractory to common treatments.

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Section: Discussionsupporting

confidence: 76%

Section: Case Reportmentioning

confidence: 99%

Successful long-term ambulatory norepinephrine infusions in a patient with pure autonomic failure

et al. 2015

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“…146 In a recent study of patients with neurogenic OH, it was shown that a precursor of norepinephrine, L-threo-3,4-dihydroxyphenylserine (L-DOPS), could significantly increase both supine and standing BP and improve orthostatic tolerance in all study subjects. Furthermore, these BP increases were closely associated with plasma norepinephrine levels.…”

Section: Sympathomimetic Agents ␣ 1 -Agonistsmentioning

confidence: 99%

Pathophysiology, Diagnosis, and Treatment of Orthostatic Hypotension and Vasovagal Syncope

Medow¹,

Stewart²,

Sanyal³

et al. 2008

Cardiology in Review

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Orthostatic hypotension (OH) occurs in 0.5% of individuals and as many as 7-17% of patients in acute care settings. Moreover, OH may be more prevalent in the elderly due to the increased use of vasoactive medications and the concomitant decrease in physiologic function, such as baroreceptor sensitivity. OH may result in the genesis of a presyncopal state or result in syncope. OH is defined as a reduction of systolic blood pressure (SBP) of at least 20 mm Hg or diastolic blood pressure (DBP) of at least 10 mm Hg within 3 minutes of standing. A review of symptoms, and measurement of supine and standing BP with appropriate clinical tests should narrow the differential diagnosis and the cause of OH. The fall in BP seen in OH results from the inability of the autonomic nervous system (ANS) to achieve adequate venous return and appropriate vasoconstriction sufficient to maintain BP. An evaluation of patients with OH should consider hypovolemia, removal of offending medications, primary autonomic disorders, secondary autonomic disorders, and vasovagal syncope, the most common cause of syncope. Although further research is necessary to rectify the disease process responsible for OH, patients suffering from this disorder can effectively be treated with a combination of nonpharmacologic treatment, pharmacologic treatment, and patient education. Agents such as fludrocortisone, midodrine, and selective serotonin reuptake inhibitors have shown promising results. Treatment for recurrent vasovagal syncope includes increased salt and water intake and various drug treatments, most of which are still under investigation.

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“…The majority of clinical trials evaluating the therapeutic effects of these substances were conducted with patients suffering from, mostly neurogenic, orthostatic hypotension [14][15][16]. In mixed samples of persons with chronic and orthostatic hypotension, reductions of subjective symptoms under the sympathomimetic etilefrine were reported [17,18].…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic determinants of chronic hypotension and their modification through vasopressor application

et al. 2008

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Chronic low blood pressure is typically accompanied by symptoms such as fatigue, reduced drive, dizziness, headaches and cold limbs. Reduced cognitive performance, diminished cerebral blood flow and autonomic dysregulation have been furthermore documented in this condition. The present contribution reports two studies exploring systemic hemodynamics in chronic hypotension and their modification through vasopressor application. In study I, effects of the alpha-sympathomimetic midodrine were examined in 54 hypotensive individuals using a placebo-controlled double-blind design. Hemodynamic parameters were assessed at rest and during mental stress. They were derived from continuous blood pressure recordings using Modelflow analysis. The drug led to marked increases in blood pressure, total peripheral resistance and stroke volume. However, due to strong heart rate deceleration, cardiac output remained virtually unchanged. In study II, 40 hypotensive and 40 normotensive control persons were compared with respect to hemodynamics. While groups did not differ in total peripheral resistance, hypotensives exhibited markedly diminished stroke volume and heart rate, resulting in a reduction in cardiac output of 25% at rest and of 33% during mental stress. The data provide relevant knowledge about the hemodynamic mediation of chronic hypotension. In contrast to elevated blood pressure, which is mainly determined by increased peripheral resistance, reduced cardiac output may be the cardinal hemodynamic aberration in chronic hypotension. Midodrine proved to be effective in elevating blood pressure. However, given the cardiac origin of chronic hypotension and the lack of drug effect on cardiac output, alpha-sympathomimetic treatment may be suboptimal.

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Ambulatory norepinephrine treatment of severe autonomic orthostatic hypotension

Cited by 39 publications

References 21 publications

Successful long-term ambulatory norepinephrine infusions in a patient with pure autonomic failure

Successful long-term ambulatory norepinephrine infusions in a patient with pure autonomic failure

Pathophysiology, Diagnosis, and Treatment of Orthostatic Hypotension and Vasovagal Syncope

Hemodynamic determinants of chronic hypotension and their modification through vasopressor application

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