title: Pharmacology of orthostatic hypotension in Parkinson's disease: from pathophysiology to management.
abstract: Orthostatic hypotension is highly prevalent in the elderly, and affects up to 20% of patients with Parkinson's disease. Pharmacological approaches help to demonstrate that Parkinson's disease is a primary autonomic failure with involvement of the peripheral autonomic nervous system as shown by decreased [(123)I] meta-iodobenzylguanidine cardiac uptake and preserved growth hormone response to clonidine. No specific clinical trial has evaluated efficacy of antihypotensive drugs in Parkinson's disease. End point of treatment should be a reduction in postural symptoms. Midodrine (Proamatin), Roberts Pharmaceutical), a vasoconstrictor and fludrocortisone (Florinef), Bristol-Myers Squibb), a volume expander are first choice drugs. No data are available on their effects on orthostatic hypotension-related morbidity. The usefulness of other drugs remains to be demonstrated. This review will highlight the importance of nonpharmacological measures in the management of orthostatic hypotension in Parkinson's disease.
authors.affiliation: Laboratoire de Pharmacologie Médicale et Clinique, INSERM U586, 37 allées Jules Guesde, 31073 Toulouse cedex, France.
authors.forename: Atul
authors.initials: A
authors.lastname: Pathak
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Senard
mesh_terms: D000978:Antiparkinson Agents / Q000009:adverse effects; D001342:Autonomic Nervous System Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D001810:Blood Volume / Q000187:drug effects; D004525:Efferent Pathways / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000139:chemically induced / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D010300:Parkinson Disease / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D019518:Postprandial Period / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000978:Antiparkinson Agents; D014662:Vasoconstrictor Agents