Table 1.

Effective Interventions to Treat Orthostatic Hypotension

Nonpharmacologic interventions

Eliminate any offending agents (α‐blockers, diuretics)

Increase fluid and salt intake

Avoid getting up quickly or standing motionless

Use of abdominal binder or compressive waist‐high stockings

Raise head of the bed by 6 to 9 inches during nighttime

Avoid prolonged standing and exposure to hot environment (hot showers)

Leg crossing while standing (cocktail party posture)

16 oz of tap water (drink as a bolus)

Exercise program (swimming, recumbent bicycle, rowing)

Pharmacologic interventions

Single agents

Increase intravascular volume

Fludrocortisone 0.1–0.3 mg/d

Adrenergic agonists and sympathomimetics (prescribe as a PRN indication rather than at fixed intervals)

Midodrine 2.5–10 mg

Pyridostigmine 60 mg

Pseudoephedrine 30 mg

Atomoxetine 18 mg

Splanchnic vasoconstrictor

Octreotide 12.5–25 µg subcutaneous

Investigational therapy

Droxidopa (L‐DOPS)

Combination therapy

Combined use of fludrocortisone (0.1–0.3 mg each morning) and midodrine (5–10 mg)

Combined use of midodrine (5–10 mg) or pseudoephedrine (30 mg) and water bolus (16 ounces)