Summary outline of non-pharmacological and pharmacological measures in the management of postural hypotension due to neurogenic failure. Non-neurogenic factors, such as fluid loss due to vomiting or diarrhoea, may substantially worsen postural hypotension and if present need to be concurrently treated
| Non-pharmacological measures |
|---|
| To be avoided |
| Sudden head-up postural change (especially on waking) |
| Prolonged recumbency |
| Straining during micturition and defecation |
| High environmental temperature (including hot baths) |
| Physical activity4-150 |
| Large meals (especially with refined carbohydrate) |
| Alcohol |
| Drugs with vasodepressor properties |
| To be introduced |
| Head up tilt during sleep |
| Small frequent meals |
| High salt intake |
| Judicious exercise (including swimming) |
| Body positions and manoeuvres |
| To be considered |
| Elastic stockings |
| Abdominal binders |
| Pharmacological measures |
| Starter drug: fludrocortisone |
| Sympathomimetic drugs: ephedrine, midodrine |
| Specific targeting: octreotide, desmopressin, erythropoietin |
↵4-150 Varies individually (see fig 1).