title: Atomoxetine for Orthostatic Hypotension in an Elderly Patient Over 10 Weeks: A Case Report.
abstract: Several nonpharmacologic strategies for orthostatic hypotension exist including avoiding large carbohydrate-rich meals; limiting alcohol consumption; maintaining adequate hydration; adding salt to foods; and using compression stockings, tilt-table exercises, or abdominal binders. If these fail, however, only limited evidence-based pharmacologic treatment options are available including the use of fludrocortisone, midodrine, pyridostigmine, and droxidopa as well as pseudoephedrine, ocetreotide, and atomoxetine. This report discusses a case of atomoxetine use for 10 weeks in an elderly patient with primary orthostatic hypotension. An 84-year-old man with long-standing primary orthostatic hypotension presented to our ambulatory cardiology pharmacotherapy clinic after several unsuccessful pharmacologic therapies including fludrocortisone, midodrine, and pyridostigmine. Nonpharmacologic strategies were also implemented. Atomoxetine was initiated, and the patient showed gradual improvements in symptoms and blood pressure control over the course of 10 weeks. Our data suggest that low-dose atomoxetine is an effective and safe agent for symptom improvement and blood pressure control in elderly patients with primary orthostatic hypotension.
authors.affiliation: Assistant Professor, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, Florida.
authors.forename: Genevieve M
authors.initials: GM
authors.lastname: Hale
authors.affiliation: Clinical Pharmacy Specialist-Cardiology, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Michael
authors.initials: M
authors.lastname: Brenner
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000069445:Atomoxetine Hydrochloride / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D006801:Humans; D007024:Hypotension, Orthostatic / Q000188:drug therapy*; D008297:Male; D016896:Treatment Outcome
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000069445:Atomoxetine Hydrochloride
keywords: atomoxetine; cardiology; geriatrics; orthostatic hypotension; pharmacy practice