Key result
Midodrine alone, pyridostigmine alone, or their combination similarly improved orthostatic blood pressure drop at 3 months, with mild to moderate adverse events in 11.5% of patients.
Why the study?
Does single or combined therapy with midodrine and pyridostigmine improve orthostatic blood pressure drop in patients with symptomatic neurogenic orthostatic hypotension?
Population
87 patients with symptomatic neurogenic orthostatic hypotension (OH)
Comparison
Midodrine only, pyridostigmine only, or… vs Active comparators
Design
RCT, randomized, open-label
Follow-up
3 months
Authors
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Supports symptomatic relief in neurogenic OH up to 3 months; leaves open need for blinded RCTs on durability and safety.
RCT (n=87)
Open-label
randomized
Does single or combined therapy with midodrine and pyridostigmine improve orthostatic blood pressure drop in patients with symptomatic neurogenic orthostatic hypotension?
Midodrine, pyridostigmine, or their combination are safe and effective for improving orthostatic BP drop in neurogenic OH up to 3 months, with midodrine offering superior symptom relief compared to pyridostigmine.
Byun et al. (2017) conducted an RCT in symptomatic neurogenic orthostatic hypotension (n=87). Midodrine, pyridostigmine, or midodrine + pyridostigmine vs. Active comparators (midodrine vs pyridostigmine vs combination) was evaluated on improvement in orthostatic blood pressure (BP) drop at 3 months. Midodrine alone, pyridostigmine alone, or their combination similarly improved orthostatic blood pressure drop at 3 months, with mild to moderate adverse events in 11.5% of patients.