Table 1.

Effective interventions to treat orthostatic hypotension

Nonpharmacologic Interventions

Eliminate any offending agents (α-blockers, diuretics)

Increase fluid and salt intake

Avoid getting up quickly or standing motionless

Use of abdominal binder or compressive waist-high stockings

Raise head of the bed by 6 to 9 inches during nighttime

Avoid prolonged standing and exposure to hot environment (hot showers)

Leg crossing while standing (cocktail party posture)

16 oz of tap water (drank as a bolus)

Exercise program (swimming, recumbent bicycle, rowing)

Pharmacologic interventions

Single agents

Increase intravascular volume

Fludrocortisone 0.1–0.3 mg/d

Adrenergic agonists and sympathomimetics (prescribe as a PRN indication rather than at fixed intervals)

Midodrine 2.5–10 mg

Pyridostigmine 60 mg

Pseudoephedrine 30 mg

Atomoxetine 18 mg

Splanchnic vasoconstrictor

Octreotide 12.5–25 mg subcutaneous

Investigational therapy

Droxidopa (L-DOPS)

Combination therapy

Combined use of fludrocortisone (0.1–0.3 mg each morning) and midodrine (5–10 mg)

Combined use of midodrine (5–10 mg) or pseudoephedrine (30 mg) and water bolus (16 ounces)