Atomoxetine for Orthostatic Hypotension in Traumatic and Non-traumatic Spinal Cord Injury: A Case Series From a Neuro-Rehabilitation Setting

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Orthostatic hypotension following spinal cord injury (n=5). Intervention: Atomoxetine. Primary outcome: Improvement in orthostatic hypotension.

Q: What does this research mean for the field?

Atomoxetine can provide clinical improvement in patients with spinal cord injury experiencing symptomatic orthostatic hypotension refractory to conventional therapy. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Navin B Prakash; Shaneena Pavithran; Anupam Gupta; Meeka Khanna

doi:10.7759/cureus.116985

September 26, 2026CureusOpen Access

Atomoxetine for Orthostatic Hypotension in Traumatic and Non-traumatic Spinal Cord Injury: A Case Series From a Neuro-Rehabilitation Setting

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Key result

Atomoxetine improves refractory orthostatic hypotension and upright tolerance in five spinal cord injury patients.

n=5

Why the study?

Evidence regarding the efficacy of atomoxetine for neurogenic orthostatic hypotension related to spinal cord injury is limited.

Does atomoxetine improve orthostatic hypotension in patients with spinal cord injury refractory to conventional management?

Key Points

To evaluate the clinical utility of atomoxetine for managing symptomatic orthostatic hypotension refractory to conventional treatments in patients with traumatic and non-traumatic spinal cord injury.
Clinical case series describing five patients (N=5) with cervical spinal cord injury (AIS B and AIS C) and symptomatic orthostatic hypotension in a neuro-rehabilitation setting.
Evaluated oral atomoxetine across a dose range of 10 mg to 23 mg following inadequate response, financial constraints, or adverse effects from standard therapies including fludrocortisone and midodrine.
All five patients demonstrated clinical improvement in symptomatic orthostatic hypotension without significant side effects such as supine hypertension or hypokalemia.
Patients achieved clinical pressor responses approximately 48 to 72 hours after initiating atomoxetine rather than within a few hours.
Blood pressure stability was maintained without evidence of a diminished pressor response during monotherapy.

Study Design

Type

Case Report (n=5)

Multicenter

No

Structured PICO

Does atomoxetine improve orthostatic hypotension in patients with spinal cord injury refractory to conventional management?

P

Population

5 men aged 18 to 55 with traumatic and non-traumatic spinal cord injury and refractory orthostatic hypotension treated with atomoxetine and followed for 3 to 6 months.

I

Intervention

Atomoxetine 10 mg to 23 mg oral daily (titrated based on clinical response).

O

Outcome

Improvement in orthostatic hypotension symptoms and seated blood pressure.surrogate

Atomoxetine may be a well-tolerated and effective alternative therapeutic option for managing orthostatic hypotension in patients with spinal cord injury who are refractory to conventional treatments.

Limitations

Tilt-table BP measurements were performed but not recorded consistently
Did not perform continuous ambulatory BP monitoring
Patients' intake of caffeinated beverages and other dietary stimulants that could affect autonomic function was not controlled
Tilt-table BP measurements were performed but not recorded consistently; therefore, they were omitted.
Did not perform continuous ambulatory BP monitoring.
Patients' intake of caffeinated beverages and other dietary stimulants that could affect autonomic function was not controlled.

Implication

May support atomoxetine for refractory orthostatic hypotension in spinal cord injury; hypothesis-generating and requires randomized confirmation before practice change.

Abstract

Orthostatic hypotension (OH) following spinal cord injury (SCI) can significantly limit functional recovery by impairing participation in rehabilitation.Non-pharmacological techniques and pharmacological therapies, including fludrocortisone and midodrine, are conventionally used to manage OH.However, when these measures fail, atomoxetine has demonstrated benefit in other neurogenic OH populations.Evidence regarding the efficacy of this selective norepinephrine reuptake inhibitor is limited in neurogenic OH related to SCI.In this case series, we describe five patients with SCI who had symptomatic OH that did not respond to conventional pharmacological agents but showed clinical improvement with atomoxetine (dose range of 10 mg to 23 mg).Hence, atomoxetine can be considered a potential alternative therapeutic option for OH related to SCI in patients with OH refractory to conventional management.

Discussion

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Cite This Study

Prakash et al. (2026) conducted a case report in Orthostatic hypotension following spinal cord injury (n=5). Atomoxetine was evaluated on Improvement in orthostatic hypotension. Atomoxetine at doses of 10 to 23 mg daily improved orthostatic hypotension and upright tolerance in five patients with spinal cord injury who were refractory to conventional management.

synapsesocial.com/papers/6abb3e235eb570e077ea1630 https://doi.org/10.7759/cureus.116985

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Atomoxetine for Orthostatic Hypotension in Traumatic and Non-traumatic Spinal Cord Injury: A Case Series From a Neuro-Rehabilitation Setting

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Atomoxetine for Orthostatic Hypotension in Traumatic and Non-traumatic Spinal Cord Injury: A Case Series From a Neuro-Rehabilitation Setting

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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