Dear Judith,
Thanks alot for posting the article below on the PD list.
My wife Aliza has this problem in addition to chronic high BP.
I am wondering whether midodrine would help her since her BP drops seem
to occur on a time scale of seconds,not hours.Subsequent BP rises occur
within minutes.Therefore it is not clear that a drug that takes an
hour to raise BP and then continues to raise BP for four hours would
be useful.Any thoughts on this? Perhaps I misunderstood the press release.
Regards.
Gil
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Date:    Tue, 21 Jul 1998 14:50:15 -0400
From:    Judith Richards <[log in to unmask]>
Subject: New drug helps orthostatic hypotension

Tuesday July 21 1:17 PM EDT

New drug helps orthostatic hypotension

NEW YORK, Jul 21 (Reuters) -- A new drug called midodrine can help
patients with neurogenic orthostatic hypotension -- a fall in blood
pressure on standing up due to neurological causes, according to a study
in the July issue of Neurology.

People with neurogenic orthostatic hypotension have normal, or even
high, blood pressure when lying down. But their blood pressure drops
precipitously when they stand. The sudden drop can cause dizziness and
fainting. A number of conditions, including PARKINSON'S disease, can
cause orthostatic hypotension. So can nerve damage due to diabetes.

The US Food and Drug Administration recently approved midodrine, which
is taken orally, for neurogenic orthostatic hypotension. To determine
the smallest effective dose of the drug, and to investigate possible
side effects at this dose, the study's authors tested midodrine among 25
people with the condition.

The researchers found that a10 milligram (mg) dose of midodrine, two to
three times daily, effectively treated symptoms and caused few side
effects. The drug, which has the brand name Proamatine, boosted blood
pressure within an hour, they found. And its effects lasted about 4
hours. A 10 mg dose caused only minor side effects, including goose
bumps, tingling and itching, the researchers report.

"This is an important step for people with orthostatic hypotension," the
study's senior author, Dr. Philip A. Low, of the Mayo Clinic in
Rochester, Minnesota, told Reuters Health in an interview.

Doctors have long prescribed a drug called fludrocortisone for people
with orthostatic hypotension, even though it is not officially approved
for this use, Low said. Fludrocortisone boosts blood pressure and,
consequently, prevents sudden drops in blood pressure upon standing. A
drawback with fludrocortisone, however, is that its effects last for
days. Since patients with orthostatic hypotension have normal or high
blood pressure while lying down, the drug causes high blood pressure at
night, when patients are sleeping.

Since midodrine takes effect within an hour, and its effects last only 4
hours, patients can take it in the morning and again in the afternoon
and get an immediate boost. By the time bedtime rolls around, though,
the effects will have worn off, so nighttime high blood pressure should
not be such a problem, Low said.

"Midodrine is best used in the morning and preceding physical activity,
and it should be avoided before bedtime," he and colleagues conclude.

Some patients taking fludrocortisone should be able to switch to
midodrine alone, Low said. Others will probably have to continue taking
fludrocortisone .By adding midodrine, though, they should be able to
take a smaller dose of fludrocortisone, Low said.

The study received funding from Roberts Pharmaceutical Corporation, of
Eatontown, New Jersey; NASA; and the Mayo Clinic, Rochester, Minnesota.
SOURCE: Neurology 1998;51:120-124.
--
Judith Richards, London, Ontario, Canada
[log in to unmask]

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