Fluoxetine hydrochloride for the treatment of severe refractory orthostatic hypotension.

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.