Table 5.

Pharmacologic management of NOH

Volume expansion
Fludrocortisone	Volume expansor (mineralocorticoid action)	0.1–0.3 mg/day q.d.	Supine hypertension, edema, and hypokalemia
Desmopressin	Vasopressin V2 receptor agonist	10–40 ug (1–4 puffs intranasal spray) nightly or 100–800 ug p.o. q.d. (usually 100–200 ug)	Water intoxication and hyponatremia
Noradrenergic stimulation replacement
Midodrine	Alpha-1 adrenoceptor agonist (pro-drug)	2.5–10 mg p.o, b.i.d. to q.i.d.	Scalp itching/piloerection, supine hypertension, coldness sensation, and urinary retention
Droxidopa	Norepinephrine precursor	100–600 mg p.o, t.i.d.	Supine hypertension, dizziness, headaches, and nausea
Harness residual sympathetic tone
Pyridostigmine	Increases ACh in autonomic ganglion synapses	30–60 mg p.o, t.i.d.	Salivation, lacrimation, bradycardia, diarrhea, urinary urgency, and sweating (some may improve other autonomic symptoms)
Atomoxetine	Norepinephrine transporter inhibitor	18 mg p.o, b.i.d	Dry mouth, headache, and anorexia

Abbreviations: NOH, neurogenic orthostatic hypotension.