Dihydroergotamine in idiopathic orthostatic hypotension: short-term intramuscular and long-term oral therapy

Clinical Pharmacology and Therapeutics
F M FouadE L Bravo

Abstract

The efficacy of dihydroergotamine (DHE-45) in the treatment of orthostatic hypotension due to deficient circulatory reflexes was investigated in 10 patients. Over the short term, intramuscular DHE-45 induced an increase (P less than 0.005) in supine blood pressure (137 +/- 8.9 to 158 +/- 8.1 mm Hg 15 min after DHE-45 and 142 +/- 9.9 to 183 +/- 7.5 mm Hg 60 min after DHE-45) associated with an increase in total peripheral resistance (TPR) (37 +/- 1.9 to 41 +/- 2.8 U . m2 and 34 +/- 2.2 to 41 +/- 2.3) and no change in cardiac output (CO), plasma renin activity (PRA), or plasma norepinephrine. Eight patients tolerated head-up tilt to a higher angle--the drop of mean arterial pressure at equivalent angles of tilt (pre- and post-DHE-45) was less. The other two patients did not improve. On the other hand, oral DHE-45 (1-mo therapy) did not induce a change in mean arterial pressure, heart rate, CO, or TPR; the only significant hemodynamic change was an increase in the ratio cardiopulmonary volume/total blood volume (12 +/- 1.9% to 16 +/- 0.7%, P less than 0.025). Changes in PRA, plasma aldosterone, and plasma catecholamines were not significant. Response to head-up tilt was variable after the first week of therapy. Blood level 2 hr af...Continue Reading

Citations

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