Nonpharmacological treatment, fludrocortisone, and domperidone for orthostatic hypotension in Parkinson's disease.
There is limited evidence for the treatment of orthostatic hypotension in idiopathic Parkinson's disease. The objective of this study was to determine the efficacy of three treatments (nonpharmacological therapy, fludrocortisone, and domperidone). Phase I assessed the compliance, safety, and efficacy of nonpharmacological measures. Phase II was a double-blind randomized controlled crossover trial of the two medications. Primary outcome measures consisted of the orthostatic domain of the Composite Autonomic Symptom Scale (COMPASS-OD), a clinical global impression of change (CGI), and postural blood pressure testing via bedside sphygmomanometry (Phase I) or tilt table testing (Phase II). For the 17 patients studied, nonpharmacological therapy did not significantly alter any outcome measure. Both medications improved the CGI and COMPASS-OD scores. There was a trend towards reduced blood pressure drop on tilt table testing, with domperidone having a greater effect.
Schoffer
Kerrie L
KL
Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, and Department of Medicine, University of Queensland, Australia. schoffer@eastlink.ca
Henderson
Robert D
RD
O'Maley
Karen
K
O'Sullivan
John D
JD
D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D018592:Cross-Over Studies; D004294:Domperidone / Q000627:therapeutic use*; D018492:Dopamine Antagonists / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005438:Fludrocortisone / Q000627:therapeutic use*; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000628:therapy; D010349:Patient Compliance; D012189:Retrospective Studies; D012720:Severity of Illness Index; D019722:Sphygmomanometers; D018667:Tilt-Table Test / Q000379:methods
D000893:Anti-Inflammatory Agents; D018492:Dopamine Antagonists; D004294:Domperidone; D005438:Fludrocortisone