Table 1.

Pharmacological Agents Used in the Treatment of Neurogenic Orthostatic Hypotension and Autonomic Failure

Medications	Mode of action	Doses
Droxidopa**	Increase norepinephrine levels	100–600 mg t.i.d.
Yohimbine (require compounding)	Stimulate residual SNS activity by antagonizing on α2 receptors	5.4 mg t.i.d.
Pyridostigmine	Enhances ganglionic transmission and SNS activity, acetylcholinesterase inhibitor, peripheral action	30–60 mg t.i.d.
Atomoxetine	Stimulate SNS by blocking norepinephrine reuptake	10–18 mg b.i.d.
Midodrine*	Direct vasoconstrictor, α1 adrenergic agonist	2.5–10 mg t.i.d.
Ergotamine and caffeine (caffergot) avoid coronary artery disease	Direct vasoconstrictor, venoconstrictor	(1 mg ergotamine, 100 caffeine) once a day
Octreotide	Splanchnic vasoconstrictor	12.5–50 ug SQ, once a day
Fludrocortisone avoid heart failure	Volume expansor, synthetic mineralocorticosteroid	0.1–0.3 mg/day
Acarbose avoid inflammatory bowel disease	Reduce post-prandial glucose and decrease insulin release and other vasoactive gut peptides	50–100 mg, ten minutes before large meal

^*Approved for the treatment of orthostatic hypotension (US, Europe, Japan);

^**Approved for the treatment of neurogenic orthostatic hypotension (US and Japan); t.i.d. three times a day; SQ subcutaneous