Fluoxetine hydrochloride for the treatment of severe refractory orthostatic hypotension

Abstract

Objective: To evaluate the usefulness of fluoxetine hydrochloride in the treatment of patients with severe refractory orthostatic hypotension.

Design: Prospective, nonrandomized study.

Patients: Five patients (3 men, 2 women with a mean age of 67 +/- 7 years with chronic symptomatic orthostatic hypotension resistant to or intolerant of other therapies.

Methods: Symptoms and orthostatic responses were recorded in the baseline state. Fluoxetine hydrochloride 20 mg orally once daily was started and patients were reevaluated after 6 to 8 weeks of therapy.

Results: All patients demonstrated orthostatic hypotension (20 mm Hg or greater decline in systolic blood pressure) associated with symptoms (eg, dizziness, vertigo, near syncope) in the baseline state. After 6 to 8 weeks of fluoxetine therapy, 2 patients reported resolution of all symptoms, 2 had a marked reduction in symptoms, and 1 patient experienced no effect. Orthostatic responses were attenuated in 4 of the 5 patients (80%).

Conclusion: Fluoxetine hydrochloride may be an effective therapy for some patients with recurrent severe orthostatic hypotension refractory to other forms of therapy.