Vasovagal syncope is a common disorder of autonomic cardiovascular regulation, Many pharmacologic agents have been proposed as effective in the management of this condition based on nonrandomized clinical trials, Nota...
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Vasovagal syncope is a common disorder of autonomic cardiovascular regulation, Many pharmacologic agents have been proposed as effective in the management of this condition based on nonrandomized clinical trials, Notably, only 3 agents-atenolol, midodrine, and paroxetine- have demonstrated efficacy in the treatment of vasovagal syncope in at least 1 prospective, randomized, placebo-controlled clinical trial. Other therapies commonly used in treating syncope include increased salt and fluid intake and fludrocortisone, In this review, we provide a summary of currently available data that support or question the use of various pharmacologic agents for treatment of vasovagal syncope, (C) 1999 by Excerpta Medica, Inc.
There is no single drug that proved effective in the treatment of orthostatic hypotension. Oral sympathomimetics like ephedrine, wyamine, aramine, and similar drugs are generally prescribed but, in our experience, the...
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There is no single drug that proved effective in the treatment of orthostatic hypotension. Oral sympathomimetics like ephedrine, wyamine, aramine, and similar drugs are generally prescribed but, in our experience, their effectiveness is unpredictable; however they should be given a trial. Mineralocorticoids have already been referred to, 9 α fluorohydrocortisone (Florinef) is the one we use. Besides producing salt and water retention and expanding the blood volume, an effect which helps venous filling of the heart, it may increase the responsiveness of arterioles to the neurotransmitter. Recently there are claims that tyramine rich foods combined with monoamine oxidase inhibitors are effective in the treatment of resistant cases of IOH, but results were not encouraging when this regimen was tried in two of our patients. All kinds of drug therapy carry the danger of precipitating hypertension. Frequent observation of arterial pressure at weekly intervals is recommended. When Florinef is prescribed one should start with a small dose (0.1 mg. per day) which can be increased gradually according to therapeutic response. In conclusion the treatment of orthostatic hypotension still presents a challenging problem. The aim should be to keep the patient active and ambulatory as long as possible.
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