Key result
Pyridostigmine may improve orthostatics and symptoms in patients with neurogenic orthostatic hypotension without causing supine hypertension, though longer-term efficacy data are conflicting.
Why the study?
Pyridostigmine is hypothesized to improve neurogenic orthostatic hypotension symptoms without causing or worsening supine hypertension, but its safety and efficacy required systematic evaluation.
Does pyridostigmine improve orthostatics and symptoms safely in patients with neurogenic orthostatic hypotension?
Systematic Review
Does pyridostigmine improve orthostatics and symptoms safely in patients with neurogenic orthostatic hypotension?
Answers are grounded in this paper and cite their sources.
Pyridostigmine may be a safe adjunctive option with a low risk of supine hypertension for managing refractory neurogenic orthostatic hypotension, though long-term efficacy data remains conflicting.
BACKGROUND: Pyridostigmine is hypothesized to improve neurogenic orthostatic hypotension (nOH) symptoms without causing or exacerbating supine hypertension. The objective of this review was to evaluate the safety and efficacy of pyridostigmine for management of nOH. METHODS: A literature search of PubMed, Embase, and CENTRAL was performed in December 2023 for prospective trials with a placebo or active comparator. RESULTS: Four randomized and two non-randomized studies were reviewed. Three studies utilizing a single dose, crossover design found significant differences of orthostatics using adjunctive pyridostigmine. Two studies assessing longer-term endpoints demonstrated conflicting efficacy of pyridostigmine with one trial finding significant improvement in orthostatics and symptoms after three months of therapy. Use of pyridostigmine did not lead to supine hypertension with most adverse effects being cholinergic. CONCLUSION: Pyridostigmine may be considered as an adjunctive medication in individuals with nOH refractory to standard treatment options as it carries a favorable safety profile with low risk for supine hypertension.
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Holder et al. (2024) conducted a systematic review in Neurogenic orthostatic hypotension (nOH). Pyridostigmine vs. Placebo or active comparator was evaluated on Safety and efficacy (orthostatics and symptoms). Pyridostigmine may improve orthostatics and symptoms in patients with neurogenic orthostatic hypotension without causing supine hypertension, though longer-term efficacy data are conflicting.
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