Table 2

Outline of the major actions by which a variety of drugs reduce orthostatic hypotension

Adapted from Mathias CJ, Kimber JR. Postural hypotension – causes, clinical features, investigation and management. Annu Rev Med 1999;:–36.

  • Reducing salt loss/plasma volume expansion

    • –mineralocorticoids (fludrocortisone)

  • Reducing nocturnal polyuria

    • –V2 receptor agonists (desmopressin)

  • Vasoconstriction: sympathetic

    • –on resistance vessels (ephedrine, midodrine, phenylephrine, noradrenaline, clonidine, tyramine with monoamine oxidase inhibitors, yohimbine, L-dihydroxyphenylserine)

    • –on capacitance vessels (dihydroergotamine)

  • Vasoconstrictor: non-sympathomimetic

    • –V1 receptor agents (terlipressin)

  • Preventing vasodilatation

    • –prostaglandin synthetase inhibitors (indomethacin, flurbiprofen)

    • –dopamine receptor blockade (metoclopramide, domperidone)

    • –β2 adrenoceptor blockade (propranolol)

  • Preventing postprandial hypotension

    • –adenosine receptor blockade (caffeine)

    • –peptide release inhibitors (somatostatin analogue: octreotide)

  • Increasing cardiac output

    • –β blockers with intrinsic sympathomimetic activity (pindolol, xamoterol)

    • –dopamine agonists (ibopamine)

  • Increasing red cell mass

    • –erythropoietin