Eur J Neurol 24
One open-label and one placebo-controlled single-dose trial in patients with neurogenic orthostatic hypotension (NOH) found statistically significant improvement in standing
Pyridostigmine in the treatment of orthostatic hypotension
Sixteen patients received the combination of pyridostigmine and yohimbine, but no evidence of synergistic pressor effect was found
Schreglmann Sr, Büchele F, Sommerauer M, et al
For example, norepinephrine transporter blockade with atomox
Another study shows that pyridostigmine is safe for use by children with POTS (absence of significant orthostatic hypotension) in three divided doses
5 mg of midodrine hydrochloride; 60 mg of pyridostigmine bromide and 5 mg of midodrine hydrochloride] and a placebo) in random order on successive days
Pyridostigmine comes as a regular tablet, an extended-release (long-acting) tablet, and a syrup to take by mouth
3
BACKGROUND Midodrine hydrochloride is the only drug demonstrated in a placebo-controlled treatment trial to improve orthostatic hypotension (OH) but it significantly worsens supine hypertension
and has fewer cholinergic side effects than neostigmine bromide and other anticholinesterase preparations
Talk to your health care provider about the risks and benefits of these drugs to determine which one is best for you
Gilhus NE, Verschuuren JJ: Myasthenia
Pyridostigmine is poorly absorbed in the gut and does not cross the blood-brain barrier
2006; 63:513–518
PMID
10 Pyridostigmine Immediate-release tablets and syrup: 60 to 1500 mg daily (usually 600 mg/day divided into 5 or 6 doses) spaced to provide maximum relief
Blood pressure (BP) measurements supine and after 3 minutes upon standing
The therapeutic goal is to improve postural symptoms, standing time, and function rather than to achieve upright normotension, which can lead to supine hypertension