| Comparative efficacy of yohimbine against pyridostigmine for the treatment of orthostatic hypotension in autonomic failure. | |
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MedLine Citation:
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PMID: 20837887 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Orthostatic hypotension affects patients with autonomic failure producing considerable disability because of presyncopal symptoms. Severely affected patients may have residual sympathetic tone that can be engaged to increase blood pressure (BP) with the α-2 adrenergic antagonist yohimbine. This medication activates sympathetic outflow centrally and unrestrains norepinephrine release from noradrenergic neurons. Alternatively, the acetylcholinesterase inhibitor, pyridostigmine, can increase sympathetic tone by improving ganglionic cholinergic neurotransmission. Our purpose was to compare these complementary approaches and to explore whether the combination would lead to synergistic increases in BP. We compared the effects of 60 mg of pyridostigmine and 5.4 mg of yohimbine in a single-blind, randomized, placebo-controlled, crossover fashion. In a subset of patients we tested the combination of pyridostigmine and yohimbine. Our primary outcome was the change in standing diastolic BP 60 minutes after drug administration from baseline. We studied a total of 31 patients with severe autonomic failure. Yohimbine significantly improved standing diastolic BP as compared with placebo (11±3 mm Hg [95% CI: 6 to 16 mm Hg]; P<0.001). On the contrary, pyridostigmine did not increase the standing diastolic BP (0.6±3 mm Hg [95% CI: -5 to 5 mm Hg]; P=0.823). Only yohimbine showed a significant improvement in presyncopal symptoms. Sixteen patients received the combination of pyridostigmine and yohimbine, but no evidence of synergistic pressor effect was found. Engaging residual sympathetic tone with yohimbine is a more effective approach to improve orthostatic hypotension as compared with pyridostigmine in patients with severe orthostatic hypotension. |
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Authors:
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Cyndya Shibao; Luis E Okamoto; Alfredo Gamboa; Chang Yu; Andre' Diedrich; Satish R Raj; David Robertson; Italo Biaggioni |
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Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural Date: 2010-09-13 |
Journal Detail:
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Title: Hypertension Volume: 56 ISSN: 1524-4563 ISO Abbreviation: Hypertension Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-10-21 Completed Date: 2010-11-10 Revised Date: 2011-11-01 |
Medline Journal Info:
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Nlm Unique ID: 7906255 Medline TA: Hypertension Country: United States |
Other Details:
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Languages: eng Pagination: 847-51 Citation Subset: IM |
Affiliation:
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Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn, USA. |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00223691 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic alpha-Antagonists
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therapeutic use Aged Analysis of Variance Blood Pressure / drug effects* Cholinesterase Inhibitors / therapeutic use Cross-Over Studies Female Heart Rate / drug effects Humans Hypotension, Orthostatic / complications, drug therapy*, physiopathology Male Middle Aged Pure Autonomic Failure / complications*, physiopathology Pyridostigmine Bromide / therapeutic use* Single-Blind Method Yohimbine / therapeutic use* |
| Grant Support | |
ID/Acronym/Agency:
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KL2-RR024977/RR/NCRR NIH HHS; P01 HL056693-15/HL/NHLBI NIH HHS; P01 HL56693/HL/NHLBI NIH HHS; R01 NS055670/NS/NINDS NIH HHS; UL1-RR24975/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic alpha-Antagonists; 0/Cholinesterase Inhibitors; 101-26-8/Pyridostigmine Bromide; 146-48-5/Yohimbine |
| Comments/Corrections | |
Comment In:
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Hypertension. 2010 Nov;56(5):811-3
[PMID:
20837880
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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