Syncope: interventional treatments
Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .
Syncope: interventional treatments. The dose is 2.5-15mg 2-4 hourly. There is a risk of supine hypertension. Fully referenced neurology checklist.
Midodrine: first line
- The dose is 2.5-15mg 2-4 hourly
- There is a risk of supine hypertension
- It should not be taken within 5 hours of bedtime
- Users should not rest or sleep supine but recumbent
- It may cause piloerection, scalp itching, and urinary retention
- Use with caution in heart and renal failure
Droxidopa: first line
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Fludrocortisone: second line
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Pyridostigmine
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Other drugs to consider
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Pacemaker: indications
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Treatments of cardiac syncope
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References
- Hale GM, Valdes J, Brenner M. The treatment of primary orthostatic hypotension. Ann Pharmacother 2017; 51:417-428.
- Gibbons CH, Schmidt P, Biaggioni I, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol 2017; 264:1567-1582.
- Moya A, Sutton R, Ammirati F, et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 2009; 30:2631-2671.
- Grubb BP. Neurocardiogenic syncope and related disorders of orthostatic intolerance. Circulation 2005; 111:2997-3006.
- Claassen D, Lew M. Initiating droxidopa for neurogenic orthostatic hypotension in a patient with Parkinson disease. Clin Auton Res 2017; 27(Suppl 1):13-14.
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