# New drug for orthostatic hypotension being researched



## Susan Purry (Nov 6, 2001)

Might be of interest to some here, who like me suffer from Neurally Meditated Hypotension (Orthostatic Hypotension/Intolerance) associated with ME/CFS. http://www.medscape.com/viewarticle/462151


> quote:*Pyridostigmine May Be Helpful in Orthostatic Hypotension*Laurie Barclay, MDSept. 26, 2003 ï¿½ The acetylcholinesterase inhibitor pyridostigmine may be beneficial for the treatment of orthostatic hypotension, according to the results of a preliminary trial published in the September issue of the Journal of Neurology, Neurosurgery, and Psychiatry. The editorialist suggests that it is now time for a well-controlled trial."A major problem of current pharmacotherapeutic options is the non-selective elevation of blood pressure regardless of the body position, with supine hypertension as a common, troublesome, and typically dose limiting side effect," write W. Singer, from the Mayo Clinic in Rochester, Minnesota, and colleagues. "We hypothesised that as ganglionic transmission is low in the supine position and is greatly increased during orthostasis, enhancing ganglionic transmission by inhibiting acetylcholinesterase might selectively reduce orthostatic hypotension without causing significant supine hypertension."In this prospective, open-label, single-dose trial, 15 patients with neurogenic orthostatic hypotension were monitored continuously during supine rest and head-up tilt before and one hour after an oral dose of 60 mg pyridostigmine. Seven patients had multiple system atrophy, three had Parkinson's disease, three had idiopathic autonomic neuropathy, one had diabetic neuropathy, and one had amyloid neuropathy.Pyridostigmine treatment was associated with a modest nonsignificant increase in supine blood pressure and peripheral resistance index (PRI), but with a significant increase in orthostatic blood pressure and PRI. Acetylcholinesterase inhibition also reduced orthostatic heart rate and fall in blood pressure during head-up tilt, and it was associated with a significant improvement in orthostatic symptoms."Enhancement of ganglionic transmission by inhibition of acetylcholinesterase appears to be an effective and generally well tolerated method of treating neurogenic orthostatic hypotension. This novel approach could be of particular value for patients with supine hypertension," the authors write. "Further studies are needed to confirm the results of this open trial in a double blind protocol. It will be important to investigate potential side effects of long term treatment carefully in this patient group and to explore the optimal dose regimen." The authors report no potential conflicts of interest.In an accompanying editorial, Ronald Schondorf, from Sir Mortimer B. Davis Jewish General Hospital in Quebec, Canada, notes the benefits of a drug that would amplify dynamic residual autonomic function without promoting supine hypertension."Given the paucity of effective agents for the treatment of orthostatic hypotension, a properly designed multicentre placebo controlled trial of the efficacy of pyridostigmine in the treatment of autonomic failure would be welcomed by those who treat patients with this condition," he writes. J Neurol Neurosurg Psychiatry. 2003;74:1187, 1294-1298


Medscape is an excellent resource if you don't already know about it. You need to register to view, but it is free.


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## M&M (Jan 20, 2002)

WOW!! Wouldn't it be great if they actually find a drug that WORKS!! Thanks for posting this Susan!


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