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Nonpharmacological treatment, fludrocortisone, and domperidone for orthostatic hypotension in Parkinson's disease

Authors

  • Kerrie L. Schoffer MD,

    Corresponding author
    1. Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
    • Division of Neurology, 2EII Health Sciences Centre, 1796 Summer St., Halifax, NS, Canada
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  • Robert D. Henderson MD,

    1. Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
    2. Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
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  • Karen O'Maley RN,

    1. Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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  • John D. O'Sullivan MBBS, MD

    1. Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
    2. Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Abstract

There is limited evidence for the treatment of orthostatic hypotension in idiopathic Parkinson's disease. The objective of this study was to determine the efficacy of three treatments (nonpharmacological therapy, fludrocortisone, and domperidone). Phase I assessed the compliance, safety, and efficacy of nonpharmacological measures. Phase II was a double-blind randomized controlled crossover trial of the two medications. Primary outcome measures consisted of the orthostatic domain of the Composite Autonomic Symptom Scale (COMPASS-OD), a clinical global impression of change (CGI), and postural blood pressure testing via bedside sphygmomanometry (Phase I) or tilt table testing (Phase II). For the 17 patients studied, nonpharmacological therapy did not significantly alter any outcome measure. Both medications improved the CGI and COMPASS-OD scores. There was a trend towards reduced blood pressure drop on tilt table testing, with domperidone having a greater effect. © 2007 Movement Disorder Society

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