A 85-year-old man with Parkinson's disease, orthostatic hypotension, and a CFS of 6 has tried non-pharmacological measures for his postural hypotensio...

Question

A 85-year-old man with Parkinson's disease, orthostatic hypotension, and a CFS of 6 has tried non-pharmacological measures for his postural hypotension (adequate fluids, salt, compression stockings, slow positional changes) without sufficient improvement. He continues to experience symptomatic drops on standing with near-syncope. What is the MOST appropriate pharmacological treatment?

Accepted Answer

Either Fludrocortisone or Midodrine - both are used; Midodrine is preferred as it has fewer side effects in older people, but choice depends on individual factors

Answer

Fludrocortisone 50-100 micrograms daily

Answer

Midodrine 2.5 mg TDS

Answer

Adrenaline auto-injector for acute episodes

Answer

Desmopressin at night

uk-dgm MCQ (SBA): Pharmacological Treatment of Orthostatic Hypotension in PD