Table 4

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)
 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).