Table 1.

Current pharmacologic treatment options for orthostatic hypotension.

Treatment	Mechanism of action	Dosage recommendation	Administration	Adverse effects
Norepinephrine replacers
Midodrine	Alpha-1 adrenoceptor agonist	Start with a 2.5 to 5 mg dose, increase up to 10 mg, up to 3 times/day	orally	Urinary retention, piloerection, supine hypertension
Droxidopa	Prodrug, converted to norepinephrine	100 to 600 mg, 3 times/day	orally	Headache, nausea, supine hypertension
Norepinephrine enhancers
Pyridostigmine	Cholinesterase inhibitor	30 to 60 mg, up to 3 times/day	orally	Abdominal discomfort, diarrhea, nausea, urinary frequency
Atomoxetine	NE transporter (NET) inhibitor	10 to 18 mg, 3 times/day	orally	Dry mouth, insomnia, loss of appetite, supine hypertension, suicidal ideation
Yohimbine	Alpha-2 adrenoreceptor antagonist	5.4 mg, up to 3 times/day (available through compounding pharmacies only)	orally	Sweating, insomnia, palpitation, suicidal ideation, supine hypertension
Nonspecific treatments
Fludrocortisone	Increasing renal sodium reabsorption and alpha-1 adrenoceptor sensitization	0.05 to 0.2 mg/day	orally	Hypokalemia, headache, edema, adrenal suppression, supine hypertension
Octreotide	Somatostatin analogue	12.5–25 μg, up to 1–3 times/day	subcutaneously	Nausea, abdominal cramps, diarrhea, flatulence, fat malabsorption