Syncope: interventional treatments

Midodrine: first line

• The dose is 2.5-15mg 2-4 hourly
• There is a risk of supine hypertension
• It should not be taken within 5 hours of bedtime
• Users should not rest or sleep supine but recumbent
• It may cause piloerection, scalp itching, and urinary retention 
• Use with caution in heart and renal failure

Droxidopa: first line

Fludrocortisone: second line

Pyridostigmine

Other drugs to consider

Pacemaker: indications

Treatments of cardiac syncope

References

1. Hale GM, Valdes J, Brenner M. The treatment of primary orthostatic hypotension. Ann Pharmacother 2017; 51:417-428. 
2. Gibbons CH, Schmidt P, Biaggioni I, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol 2017; 264:1567-1582. 
3. Moya A, Sutton R, Ammirati F, et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 2009; 30:2631-2671.
4. Grubb BP. Neurocardiogenic syncope and related disorders of orthostatic intolerance. Circulation 2005; 111:2997-3006.
5. Claassen D, Lew M. Initiating droxidopa for neurogenic orthostatic hypotension in a patient with Parkinson disease. Clin Auton Res 2017; 27(Suppl 1):13-14.
6. And 2 more. Subscribe to see the full list

Related checklists

• Syncope: red flags for admission
• Syncope: preventive measures