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Parkinson's disease - Management
How do I manage postural (orthostatic) hypotension in people with Parkinson's disease?
- Consider a stepped approach to the management of postural (orthostatic) hypotension in Parkinson's disease:
- Stop or reduce the dose of antihypertensive medications.
- Reduce or change anti-parkinsonian drugs after discussion with specialist services.
- Advise the person to increase their dietary salt and fluid intake, to avoid caffeine at night, to eat frequent, small meals, and to avoid alcohol.
- Advise the person to elevate the head of their bed by 30–40 degrees.
- Consider prescribing compression stockings after excluding arterial insufficiency (see the CKS topic on Compression stockings).
- Consider referring people with persistent or troublesome symptoms to a unit with expertise in falls and syncope.
- A salt-retaining steroid (such as fludrocortisone) may be recommended.
- Occasionally, midodrine (a direct-acting sympathomimetic) may be prescribed, but this is only available on a named-patient basis.
In depth
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