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Atomoxetine for Orthostatic Hypotension in an Elderly Patient Over 10 Weeks: A Case Report
Author(s) -
Hale Genevieve M.,
Brenner Michael
Publication year - 2015
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1635
Subject(s) - midodrine , fludrocortisone , orthostatic vital signs , medicine , atomoxetine , anesthesia , blood pressure , lightheadedness , compression stockings , surgery , attention deficit hyperactivity disorder , hydrocortisone , psychiatry , thrombosis , methylphenidate
Several nonpharmacologic strategies for orthostatic hypotension exist including avoiding large carbohydrate‐rich meals; limiting alcohol consumption; maintaining adequate hydration; adding salt to foods; and using compression stockings, tilt‐table exercises, or abdominal binders. If these fail, however, only limited evidence‐based pharmacologic treatment options are available including the use of fludrocortisone, midodrine, pyridostigmine, and droxidopa as well as pseudoephedrine, ocetreotide, and atomoxetine. This report discusses a case of atomoxetine use for 10 weeks in an elderly patient with primary orthostatic hypotension. An 84‐year‐old man with long‐standing primary orthostatic hypotension presented to our ambulatory cardiology pharmacotherapy clinic after several unsuccessful pharmacologic therapies including fludrocortisone, midodrine, and pyridostigmine. Nonpharmacologic strategies were also implemented. Atomoxetine was initiated, and the patient showed gradual improvements in symptoms and blood pressure control over the course of 10 weeks. Our data suggest that low‐dose atomoxetine is an effective and safe agent for symptom improvement and blood pressure control in elderly patients with primary orthostatic hypotension.