Table 1.

Pharmacological treatments for neurogenic orthostatic hypotension.

Treatment	Recommended dosing regimen	Mechanism of action	Adverse events
Specifically approved for symptomatic neurogenic OH
Midodrine	2.5–15 mg twice or three times/day (dosed morning, midday, and 3–4 hours prior to bedtime)	Direct α1-adrenergic receptor agonist	Supine hypertension, piloerection (“goose bumps”), scalp itching, and urinary retention; caution in congestive heart failure and chronic renal failure
Droxidopa	100–600 mg three times/day (dosed morning, midday, and 3–4 hours prior to bedtime) or tailored to the patients' needs	Synthetic norepinephrine precursor	Supine hypertension, headache, dizziness, nausea, and fatigue; caution in congestive heart failure and chronic renal failure
Not specifically approved for neurogenic OH
Atomoxetine	10-18 mg twice a day	Norepinephrine transporter (NET) blocker	Supine hypertension, insomnia, irritability, decreased appetite
Fludrocortisone	0.05–0.2 mg/day; little benefit observed with dosages beyond 0.2 mg/day	Synthetic mineralocorticoid. Volume expander that increases sodium and water reabsorption	Supine hypertension, hypokalemia, renal failure, and edema; caution in congestive heart failure
Pyridostigmine	30–60 mg twice or three times/day	Acetyl-cholinesterase inhibitor. Marginal efficacy in neurogenic orthostatic hypotension.	Abdominal cramps, diarrhea, sialorrhea, excessive sweating, urinary incontinence.