RESUMO
INTRODUCTION: L-threo-3,4-dihydroxyphenylserine (droxidopa), a pro-drug metabolized to norepinephrine in nerve endings and other tissues, has been commercially available in Japan since 1989 for treating orthostatic hypotension symptoms in Parkinson's disease (PD) patients with a Hoehn & Yahr stage III rating, as well as patients with Multiple System Atrophy (MSA), familial amyloid polyneuropathy, and hemodialysis. Recently, the FDA has approved its use in symptomatic neurogenic orthostatic hypotension (NOH). Areas covered: The authors review the effects of droxidopa in NOH with a focus on the neurodegenerative diseases PD, MSA, and pure autonomic failure (PAF). Expert opinion: A few small and short placebo-controlled clinical trials in NOH showed significant reductions in the manometric drop in blood pressure (BP) after posture changes or meals. Larger Phase III studies showed conflicting results, with two out of four trials meeting their primary outcome and thus suggesting a positive yet short-lasting effect of the drug on OH Questionnaire composite score, light-headedness/dizziness score, and standing BP during the first two treatment-weeks. Results appear essentially similar in PD, MSA, and PAF. The FDA granted droxidopa approval in the frame of an 'accelerated approval program' provided further studies are conducted to assess its long-term effects on OH symptoms.
Assuntos
Droxidopa/uso terapêutico , Hipotensão Ortostática/tratamento farmacológico , Doenças Neurodegenerativas/tratamento farmacológico , Neuropatias Amiloides Familiares/tratamento farmacológico , Pressão Sanguínea , Humanos , Japão , Doenças Neurodegenerativas/fisiopatologia , Doença de Parkinson/tratamento farmacológico , Diálise Renal , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Orthostatic hypotension (OH) is a rare manifestation of medulla oblongata lesions that may be because of interruption of descending sympathoexcitatory axons. AIMS: To illustrate the location of a medullary lesion that produced OH following resection in relationship to the location of putative sympathoexcitatory pathways. METHOD: A case with dorsal medullary cavernous angioma presenting with OH is described. The possible localization of lesion was compared with distribution of tyrosine hydroxylase (TH)-immunoreactive axons in a comparable section of the medulla of a control brain. RESULTS: The patient had marked OH after partial removal of the cavernous angioma. Biopsy confirmed the diagnosis. The magnetic resonance imaging location of the lesion overlapped that of TH-immunoreactive axons of the medullary transtegmental tract. CONCLUSIONS: A restricted lesion of medullary lesion interrupting the catecholaminergic transtegmental tract arising from the sympathoexcitatory C1 neurons of the rostral ventrolateral medulla could result in severe OH.
Assuntos
Neoplasias do Tronco Encefálico/diagnóstico , Fludrocortisona/uso terapêutico , Hemangioma Cavernoso/diagnóstico , Hipotensão Ortostática/etiologia , Midodrina/uso terapêutico , Agonistas alfa-Adrenérgicos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Ataxia/etiologia , Feminino , Humanos , Hipotensão Ortostática/tratamento farmacológico , Imageamento por Ressonância Magnética , Bulbo/patologia , Pessoa de Meia-Idade , Postura , Vertigem/etiologiaRESUMO
São relatados os casos de dois idosos portadores de hipertensão arterial sistêmica(HAS) associada à hipotensão ortostática (HO) sintomática que foram tratados com quinalapril (20mg/dia), um inibidor da enzima conversora de angiotensina, após utilização infrutífera de várias classes de anti-hipertensivos, com resultados satisfatórios.
The cases of two aged people with systemic arterial hypertension (SAH) (hipertensão arterial sistêmica (HAS)) related to symptomatic orthostatic hypotension (OH) are reported to be treated with quinalapril (20mg/day)...
Assuntos
Humanos , Idoso , Angiotensinas/uso terapêutico , Hipertensão/tratamento farmacológico , Hipotensão Ortostática/tratamento farmacológico , Peptidil Dipeptidase A/uso terapêutico , Anti-Hipertensivos/uso terapêuticoRESUMO
We describe the effect of propranolol in an adolescent with chronic fatigue syndrome and orthostatic intolerance. Our observations suggest that the head-up tilt-test and beta-blocker treatment might be considered in patients with chronic fatigue syndrome and that enhanced sympathetic nervous activity might be part of the underlying pathophysiology.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Síndrome de Fadiga Crônica/tratamento farmacológico , Hipotensão Ortostática/tratamento farmacológico , Propranolol/uso terapêutico , Adolescente , Síndrome de Fadiga Crônica/fisiopatologia , Humanos , Hipotensão Ortostática/fisiopatologia , MasculinoRESUMO
In patients with an orthostatic intolerance, the hemodynamic response to standing, may identify an abnormality know as postural orthostatic tachycardia syndrome or orthostatic hypotension, that can often be treated without further testing. When the response to standing is normal, tilt-table testing may be useful in making the diagnosis of vasovagal syncope or postural orthostatic tachycardia syndrome and guiding treatment. In evaluating the results of tilt-table testing, an important consideration is the distinction between vasovagal syncope, and the dysautonomic response to tilt characterized by a gradual and progressive decrease in blood pressure that leads to syncope. Current practice patterns suggest that beta blockers, fludrocortisone, and midodrine are commonly used to treat patients with vasovagal syncope. These also suggest that patients with the postural orthostatic tachycardia syndrome, and with the dysautonomic response, are better treated with fludrocortisone and midodrine.
Assuntos
Hipotensão Ortostática , Síncope , Taquicardia , Humanos , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/tratamento farmacológico , Postura , Síncope/diagnóstico , Síncope/tratamento farmacológico , Síndrome , Taquicardia/diagnóstico , Taquicardia/tratamento farmacológicoRESUMO
A 38 year-old woman, with orthostatic hypotension secondary to autonomic dysfunction accompanied by sympathetic hyperactivity and excess of dopamine, was treated with an antagonistic dopaminergic drug, metoclopramide, 30 mg/day, with good tolerance. Support intervention as well as the use of various drugs (beta-blockers, caffeine, fludrocortisone, haloperidol) showed no effect. The answer to metoclopramide both subjective and objective were remarkable. The way in which metoclopramide acts has not yet been fully clarified. Being a widely used drug, well tolerated, its use must be considered in cases of severe orthostatic hypotension, especially those with an excess of dopamine.
Assuntos
Hipotensão Ortostática/tratamento farmacológico , Metoclopramida/uso terapêutico , Adulto , Feminino , HumanosRESUMO
Mulher de 38 anos, portadora de hipotensäo ortostática (HO) grave, secundária à disfunçäo autonômica, com hiperatividade simpática e excesso de dopamina, tratada com droga antagonista dopaminérgica, metoclopramida, na dose de 30mg/dia. As intervençöes clássicas de suporte, assim como, o uso de diferentes fármacos (ß-bloqueadores, cafeína, haloperidol e alfa-fludrocortisona) foram eficazes. A resposta à metoclopramida, tanto subjetiva (queixas de tonteiras despareceram) quanto objetiva (näo mais se detectou quedas posturais na pressäo arterial ao exame físico) foi considerável. O mecanismo de açäo pelo qual a metoclopramida atua na HO näo foi ainda totalmente esclarecido. Por ser uma droga de ampla utilizaçäo clínica e de boa tolerância, seu uso deve ser considerado nos casos de HO grave, particularmente quando acompanhada de excesso de dopamina
Assuntos
Humanos , Feminino , Adulto , Metoclopramida/uso terapêutico , Hipotensão Ortostática/tratamento farmacológicoRESUMO
Presentamos los resultados de administrar un péptido vasoactivo como el octreótido en un paciente portador del síndrome de Shy-Drager, enfermedad que cursa con hipotensión ortostática severa. En este trabajo se describen los efectos de la prueba de inclinación o Tilt test. Durante el estudio basal, nuestro paciente desarrolló hipotensión ortostática severa, con el octreótido se observó un aumento significativo de la presión arterial diastólica sobre todo durante la inclinación a 60o. Este incremento es probablemente secundario a la vasoconstricción esplácnica producida por el octreótido, evitando la caída de la presión al redistribuir la volemia. El octreótido estaría indicado en casos refractarios para prevenir síntomas (AU)