Hoeldtke R D, Cavanaugh S T, Hughes J D, Polansky M
Ann Intern Med. 1986 Aug;105(2):168-73. doi: 10.7326/0003-4819-105-2-168.
Eight patients with orthostatic hypotension were treated with subcutaneous dihydroergotamine. Two doses of the drug (6.5 and 13 micrograms/kg) or placebo were given in a random sequence at 0600 h, and blood pressures were measured hourly throughout the day with patients in both supine and upright positions. To assess the effect of postprandial hypotension on the therapeutic response to dihydroergotamine, we gave breakfast, lunch, and supper on a fixed schedule at 0900 h, 1200 h, and 1700 h. Dihydroergotamine had a pressor effect in seven of the eight patients during the fasting period (0600 h to 0900 h), but this agent did not counteract the hypotensive effect of eating. Concomitant administration of caffeine (250 mg, 30 minutes before breakfast), however, maintained the beneficial effect of dihydroergotamine during the postprandial period. The combination of subcutaneous dihydroergotamine and caffeine represents a new therapeutic option for patients with severe autonomic neuropathy.
8例体位性低血压患者接受了皮下注射双氢麦角胺治疗。在06:00时，随机依次给予两剂药物（6.5和13微克/千克）或安慰剂，全天每小时测量患者仰卧位和直立位的血压。为评估餐后低血压对双氢麦角胺治疗反应的影响，我们在09:00、12:00和17:00按固定时间表提供早餐、午餐和晚餐。在禁食期（06:00至09:00），8例患者中有7例双氢麦角胺有升压作用，但该药物并未抵消进食的降压作用。然而，早餐前30分钟同时服用咖啡因（250毫克）可在餐后维持双氢麦角胺的有益作用。皮下注射双氢麦角胺与咖啡因联合使用为严重自主神经病变患者提供了一种新的治疗选择。
