Holder Amanda C, Dylewski Angela, Brown Jamie N
Geriatric Research Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA.
Pharmacy Service, Durham VA Health Care System, Durham, NC, USA.
J Geriatr Psychiatry Neurol. 2025 Mar;38(2):85-93. doi: 10.1177/08919887241266800. Epub 2024 Jul 23.
Pyridostigmine is hypothesized to improve neurogenic orthostatic hypotension (nOH) symptoms without causing or exacerbating supine hypertension. The objective of this review was to evaluate the safety and efficacy of pyridostigmine for management of nOH.
A literature search of PubMed, Embase, and CENTRAL was performed in December 2023 for prospective trials with a placebo or active comparator.
Four randomized and two non-randomized studies were reviewed. Three studies utilizing a single dose, crossover design found significant differences of orthostatics using adjunctive pyridostigmine. Two studies assessing longer-term endpoints demonstrated conflicting efficacy of pyridostigmine with one trial finding significant improvement in orthostatics and symptoms after three months of therapy. Use of pyridostigmine did not lead to supine hypertension with most adverse effects being cholinergic.
Pyridostigmine may be considered as an adjunctive medication in individuals with nOH refractory to standard treatment options as it carries a favorable safety profile with low risk for supine hypertension.
据推测，吡啶斯的明可改善神经源性直立性低血压（nOH）症状，且不会引起或加重卧位高血压。本综述的目的是评估吡啶斯的明治疗nOH的安全性和有效性。
2023年12月，对PubMed、Embase和CENTRAL进行文献检索，以查找使用安慰剂或活性对照的前瞻性试验。
回顾了四项随机研究和两项非随机研究。三项采用单剂量交叉设计的研究发现，使用辅助吡啶斯的明后，直立性指标存在显著差异。两项评估长期终点的研究显示，吡啶斯的明的疗效存在冲突，其中一项试验发现，治疗三个月后，直立性指标和症状有显著改善。使用吡啶斯的明不会导致卧位高血压，大多数不良反应为胆碱能性。
对于标准治疗方案难治的nOH患者，可考虑将吡啶斯的明作为辅助药物，因为它具有良好的安全性，发生卧位高血压的风险较低。
