What are the potential pharmacological treatments for managing symptoms of dysautonomia, and how should they be monitored?

For managing symptoms of dysautonomia, specifically orthostatic hypotension in people with Parkinson's disease, pharmacological treatments are available ¹.

• Pharmacological Treatments:
• Initially, a review of the person's existing medicines, such as antihypertensives (including diuretics), dopaminergics, anticholinergics, and antidepressants, should be undertaken to address possible pharmacological causes of orthostatic hypotension ¹.
• Midodrine can be considered for people with Parkinson's disease and orthostatic hypotension ¹.
• If midodrine is contraindicated, not tolerated, or not effective, fludrocortisone may be considered ¹. It is important to note that in July 2017, the use of fludrocortisone for this indication was off-label ¹.
• Monitoring Effectiveness and Safety:
• When considering midodrine, its contraindications and monitoring requirements, including monitoring for supine hypertension, must be taken into account ¹.
• If fludrocortisone is considered, its safety profile, particularly its cardiac risk and potential interactions with other medicines, should be carefully considered ¹.