Therapeutics of Clinical Drugs 姿 態 性 低 血 壓 臨 床 治 療 嘉 義 長 庚 紀 念 醫 院 藥 劑 科 藥 師 林 佩 姿 摘 要 midodrine fludrocortisones pyridostigmine midodrinefludrocortisonepyridostigmine 壹 前 言 5-10 mmhg 5-10 mmhg (10-25/) 3 20 mmhg 10 mmhg (dmentia with Lewy-Bodies) (baroreceptor) 1 B12 2-5 貳 疾 病 機 轉 和 臨 床 症 狀 500-1,000 ml baroreceptor 4 291 藥 學 雜 誌 第 114 冊 109
Therapeutics of Clinical Drugs 參 臨 治 療 方 式 一 非 藥 物 治 療 (physical maneuvers) 2-5 表 一 非 藥 物 治 療 策 略 10-20 ( 一 ) 停 用 引 發 問 題 的 藥 物 ( ) ( 二 ) 病 人 衛 和 身 體 調 節 策 略 4 ( ) ( 三 ) 增 加 鹽 分 和 水 分 的 攝 取 (2-2.5 L/day ) (> 170 mmol) (>1,500 ml) 170 mmol 1-2 g 3-4 (500 ml) 530 mmhg 二 藥 物 治 療 110 THE JOURNAL OF TAIWAN PHARMACY Vol.29 No.1
50% Fludrocortisone Midodrine fludrocortisones midodrine 6,7 2.5 mg 40 mgmidodrine desglymidodrine0.5-1 2-4 3 46 Ephedrine pseudoephedrine αβ β2 midodrine (8.4 mg ) ephedrine (22.3 mg ) 8 pyridostigmine 9 60 mg 58 4pyridostigmine 60 mg midodrine 10 11 erythropoietin desmopressinsomatostatindihydroergot-dihydroergot- amine norepinephrine prostaglanding arachidonic fludrocortisones midodrine desmopressin V2V1 Somatostatin octreotide Dihydroergotamine α1 291 藥 學 雜 誌 第 114 冊 111
Therapeutics of Clinical Drugs metoclopramide domperidone noradrenaline 三 仰 臥 高 血 壓 的 處 置 nitroglycerine ( ) 3 4 表 二 姿 態 性 低 血 壓 的 藥 物 治 療 Fludrocortisone Midodrine Pyridostigmine Erythropoietin catecholamine nor-epinephrine α1 12 0.05-0.3 mg / 1mg/ 3,5 2.5 mg 10 mg 40 mg / 30 mg60 mg 25-75 U/kg 25 U/kg 肆 結 論 參 考 資 料 : 1. tan GH, Hermanson B, Bild DE, et al: Orthostatic hypotension in older adults. The Cardiovascular Health Study. CHS Collaborative Research Group. Hypertension 1992; 19(6 pt 1): 508-19. 2. eeman R. Clinical practice. Neurogenic orthostatic hypotension. The New England Journal of Medicine 2008; 358(6): 615-24. 3. ufmann H, Freeman R, Kaplan NM. Treatment of orthostatic and postprandial hypotension, In: UpToDate, Amin- 112 THE JOURNAL OF TAIWAN PHARMACY Vol.29 No.1
off MJ (Ed), UpToDate 2010. 4. w PA, Singer W. Management of neurogenic orthostatic hypotension: an update. The Lancet Neurology 2008; 7(5): 451-8. 5. nier JB, Mote MB, Clay EC. Evaluation and management of orthostatic hypotension. American Family Physician 2011; 84(5): 527-36. 6. w PA, Gilden JL, Freeman R, et al: Efficacy of midodrine vs placebo in neurogenic orthostatic hypotension: A Randomized, Double-blind Multicenter Study Journal of the American Medical Association 1997; 277(13): 1046-51. 7. ight RA, Kaufmann HC, Perera R, et al: A double-blind, dose-response study of midodrine in neurogenic orthostatic hypotension. Neurology 1998; 51(1): 120-4. 8. uad-tarazi FM, Okabe M, Goren H. Alpha sympathomimetic treatment of autonomic insufficiency with orthostatic hypotension. The American Journal of Medicine 1995; 99(6): 604-10. 9. nger W, Opfer-Gehrking TL, McPhee BR, et al: Acetylcholinesterase inhibition: a novel approach in the treatment of neurogenic orthostatic hypotension. Journal of Neurology, Neurosurgery & Psychiatry 2003; 74(9): 1294-8. 10. ger W, Sandroni P, Opfer-Gehrking TL, et al: Pyridostigmine treatment trial in neurogenic orthostatic hypotension. Archives of Neurology 2006; 63(4): 513-8. 11. bao C, Okamoto LE, Gamboa A, et al. Comparative efficacy of yohimbine against pyridostigmine for the treatment of orthostatic hypotension in autonomic failure. Hypertension 2010; 56(5): 847-51. 12. ldtke RD, Streeten D. Treatment of orthostatic hypotension with erythropoietin. The New England Journal of Medicine 1993; 329(9): 611-5. Clinical Managements of Orthostatic Hypotension Pei-Tzu Lin Department of Pharmacy, Chiayi Chang Gung Memorial Hospital Abstract Dual treatment strategies are recommended for orthostatic hypotension, including nonpharmacotherapy and pharmacotherapy. Non-pharmacotherapy is suitable for all patients. Reducing troublesome symptom of orthostatic hypotension by physical maneuvers, compression stockings and change posture slowly. Considering pharmacotherapy is proper to no response to nonpharmacotherapy. Midodrine is the only one medicine approved by US FDA. Besides, fludrocortisones and pyridostigmine have positive impact for orthostatic patients. Treatment goals of medicine are to ameliorate annoying symptoms and avoid adverse effect of drug, not to maintain blood pressure in normal range. As that, following the efficacy and adverse event associated with medicine are essential thing. 291 藥 學 雜 誌 第 114 冊 113