TUESDAY, Feb. 13 (HealthDay News) -- The cholinesterase inhibitor pyridostigmine bromide alone or in combination with midodrine can correct neurogenic orthostatic hypotension, Mayo Medical Center researchers report in the Feb. 13 issue of the Archives of Neurology.
The researchers, led by Wolfgang Singer, M.D., of Rochester, Minn., conducted a randomized, placebo-controlled, double-blind, cross-over study of a single dose of 60 mg pyridostigmine alone, in combination with 2.5 mg of midodrine or in combination with 5 mg of midodrine. A total of 58 patients received treatment in the four arms on successive days. Heart rate and standing and lying blood pressures were measured before treatment and then hourly for six hours after the day's treatment.
There were no significant differences in supine blood pressure between the treatment arms. The drop in standing diastolic blood pressure was significantly reduced in all active treatment arms compared with placebo. With placebo, there was a 34 mm Hg drop in diastolic blood pressure on standing, which was reduced to 27.6 mm Hg with pyridostigmine alone and 27.2 mm Hg with pyridostigmine plus 5 mg of midodrine.
Since pyridostigmine's effect is greatest on diastolic blood pressure, the authors conclude that the drug's effect is primarily on increasing total peripheral resistance.
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