Pyridostigmine in the Treatment of Orthostatic Intolerance

  title={Pyridostigmine in the Treatment of Orthostatic Intolerance},
  author={Barry J. Gales and Mark A Gales},
  journal={Annals of Pharmacotherapy},
  pages={314 - 318}
Objective: To review the efficacy of pyridostigmine bromide for the treatment of orthostatic intolerance. Data Sources: MEDLINE and International Pharmaceutical Abstracts were searched (1966–December 2006) using the terms pyridostigmine, acetylcholinesterase inhibitor, orthostatic intolerance, orthostatic hypotension, neurogenic orthostatic hypotension, postural tachycardia syndrome, tachycardia, and orthostatic tachycardia. Study Selection and Data Extraction: Pertinent English-language human… 

Utilisation of medications to reduce symptoms in children with postural orthostatic tachycardia syndrome

Symptoms associated with this disorder can be effectively managed with various medications, and further randomised studies are needed to better ascertain true efficacy compared with placebo.

Postural orthostatic tachycardia syndrome following Lyme disease.

In an appropriate clinical setting, evaluation for POTS in patients suffering from post LD syndrome may lead to early recognition and treatment, with subsequent improvement in symptoms of orthostatic intolerance.

Pathophysiology and Treatment of Orthostatic Hypotension in Parkinsonian Disorders

The inadequate release of peripheral norepinephrine upon orthostatic stress is a final pathologic pathway for neurogenic OH and is important for many therapeutic interventions.

Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management

The overall effects of pharmacological therapy are modest and the most affected patients remain handicapped, so future efforts should focus on better understanding of POTS pathophysiology and designing randomized controlled trials for selection of more effective therapy.

A Practical Guide to the Treatment of Neurogenic Orthostatic Hypotension

  • M. BergerK. Kimpinski
  • Medicine
    Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques
  • 2014
The purpose of this review is to provide the clinician with a practical approach to the diagnosis and management of neurogenic orthostatic hypotension.

Pediatric Disorders of Orthostatic Intolerance

Putative causes of OI, such as gravitational and exercise deconditioning, immune-mediated disease, mast cell activation, and central hypovolemia, are described as well as frequent comorbidities,such as joint hypermobility, anxiety, and gastrointestinal issues.

Pyridostigmine in the Treatment of Postural Orthostatic Tachycardia: A Single‐Center Experience

A retrospective, single‐center, long‐term experience regarding the efficacy and adverse effect profile of pyridostigmine in the treatment of POTS patients is reported.

Diagnosis and management of postural orthostatic tachycardia syndrome: A brief review

This syndrome appears to describe a group of conditions with differing pathophysiology, which requires treatment tailored to the true underlying disorder, which needs to be fully evaluated to guide treatment.

Current Pharmacological Management of Hypotensive Syndromes in the Elderly

Standard medication management recommendations based on evidence are lacking for many medications used in treating these hypotensive syndromes, and different medication groups have been shown to be useful.



Pyridostigmine treatment trial in neurogenic orthostatic hypotension.

Pyridostigmine significantly improves standing BP in patients with OH without worsening supine hypertension, suggesting that the improvement is due to increased total peripheral resistance.

Acetylcholinesterase Inhibition in Patients With Orthostatic Intolerance

It is concluded that pyridostigmine improves orthostatic tolerance in patients with OI and support the suggested mechanisms of enhanced sympathetic ganglionic neurotransmission and a vagal shift in cardiac sympathovagal balance.

Acetylcholinesterase inhibition: a novel approach in the treatment of neurogenic orthostatic hypotension

This novel approach to treatment using acetylcholinesterase inhibition appears effective in the treatment of neurogenic orthostatic hypotension, specially for patients with a high supine blood pressure.

Pharmacokinetics of Pyridostigmine in a Child With Postural Tachycardia Syndrome

The pharmacokinetic evaluation of pyridostigmine in children with myasthenia and a pediatric index patient with severe postural orthostatic tachycardia syndrome revealed a short half-life, suggesting that dosing 3 times per day is preferable.

Acetylcholinesterase inhibition and orthostatic hypotension

The case of a 68 years old woman who, over the years, developed a progressive autonomic failure due to postganglionic cholinergic denervation, suggests that pyridostigmine does not only affect orthostatic, but also supine BP and heart rate and advises caution in prescribing it to patients at risk of supine hypertension and arrhythmias.

Acetylcholinesterase Inhibition Improves Tachycardia in Postural Tachycardia Syndrome

Acute acetylcholinesterase inhibition significantly attenuated tachycardia in POTS and there was also an improvement in symptom burden with this promising therapy.

Pyridostigmine for treatment of neurogenic orthostatic hypotension [correction of hypertension]--a follow-up survey study.

The result of a follow-up, open-label study of pyridostigmine for treatment of orthostatic hypotension was that most patients were very satisfied with the medication and chose to continue it.

Neurocardiogenic Syncope and Related Disorders of Orthostatic Intolerance

The present system of classification has proven both functional and clinically relevant and includes a group of disorders that most investigators have thought to be principally autonomic in nature.

The Elusive Pathophysiology of Neurally Mediated Syncope

This review critically evaluates proposed theories that attempt to explain the pathophysiological mechanisms of Neurally mediated syncope (NMS), a common clinical problem that affects up to 3.5% of the general population.