Orthostatic hypotension in Parkinson disease

Orthostatic hypotension is common in Parkinson disease and can have serious results (eg falls, injuries).

Review the patient's antiparkinson drugs and other drugs (eg antihypertensive drugs).

Advise patients to:

  • avoid extreme heat, alcohol, large meals, straining and standing up rapidly
  • increase sodium and water intake
  • eat smaller, more frequent meals
  • take regular exercise in the horizontal position (eg swimming)
  • wear compression stockings
  • sleep with the head of the bed raised.

If pharmacological treatment is needed, use:

fludrocortisone 0.1 mg orally, daily, increasing to 0.2 mg daily if needed. orthostatic hypotension (Parkinson disease) fludrocortisone    

In resistant cases, seek expert advice—pyridostigmine, midodrine, ephedrine1 and octreotide may be useful.

1 Ephedrine as an oral preparation is not registered for use in Australia but is available via the Special Access Scheme.Return