Table 3.

Pharmacologic treatments for neurogenic orthostatic hypotension

Modified from [1]

Treatment	Recommended dosing regimen	Drug class and notes	Safety notes
FDA-approved for the treatment of symptomatic neurogenic OH
Droxidopa	100–600 mg three times/day (dosed morning, midday, and 3–4 h prior to bedtime) or tailored to each patients’ needs	Pro-drug of norepinephrine	Supine hypertension, headache, dizziness, nausea, and fatigue; caution in congestive heart failure and chronic renal failure
Midodrine	2.5–15 mg twice or three times/day (dosed morning, midday, and 3–4 h prior to bedtime)	Direct alpha1-adrenoreceptor agonist	Supine hypertension, piloerection, scalp itching, and urinary retention; caution in congestive heart failure and chronic renal failure
Not specifically FDA-approved for neurogenic OH
Fludrocortisone	0.1–0.2 mg/day; little benefit from observed dose beyond 0.2 mg/day	Synthetic mineralocorticoid. Fludrocortisone is a volume expander that increases sodium reabsorption and enhances sensitivity of alpha-adrenoreceptors	Supine hypertension, hypokalemia, renal failure, and edema; caution in congestive heart failure
Pyridostigmine	30–60 mg twice or three times/day	Acetylcholinesterase inhibitor. Marginal efficacy in nOH	Abdominal cramps, diarrhea, sialorrhea, excessive sweating, urinary incontinence