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

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 21 August 2025Updated: 21 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

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

  • 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 .
    • Midodrine can be considered for people with Parkinson's disease and orthostatic hypotension .
    • If midodrine is contraindicated, not tolerated, or not effective, fludrocortisone may be considered . It is important to note that in July 2017, the use of fludrocortisone for this indication was off-label .
  • Monitoring Effectiveness and Safety:
    • When considering midodrine, its contraindications and monitoring requirements, including monitoring for supine hypertension, must be taken into account .
    • If fludrocortisone is considered, its safety profile, particularly its cardiac risk and potential interactions with other medicines, should be carefully considered .

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