From the Guidelines
If a patient with Parkinson's disease on levodopa and quetiapine experiences syncope while seated, immediate medical attention should be sought to address potential orthostatic hypotension. The patient should be placed in a supine position with legs elevated to improve cerebral blood flow, and vital signs, particularly blood pressure and heart rate, should be checked as both medications can cause orthostatic hypotension 1. The next dose of both medications should be discontinued until medical evaluation occurs. A medication review is essential, as dosage adjustments may be needed, and hydration status should be assessed, with adequate fluid intake encouraged 1. Long-term management may include blood pressure monitoring, medication timing adjustments, compression stockings, or adding medications like fludrocortisone or midodrine if orthostatic hypotension is confirmed as the cause, as suggested by the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope 1. Some key considerations for managing orthostatic hypotension include:
- Acute water ingestion for temporary relief
- Physical counter-pressure maneuvers
- Compression garments
- Midodrine or droxidopa for neurogenic orthostatic hypotension
- Fludrocortisone for increasing plasma volume
- Encouraging increased salt and fluid intake in selected patients
- Pyridostigmine or octreotide for refractory cases, as outlined in the guideline 1. Given the potential for orthostatic hypotension with levodopa and quetiapine, as noted in the context of managing delirium symptoms 1, careful management and monitoring are crucial to prevent morbidity and mortality, and to maintain quality of life.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Management of Syncope in Parkinson's Disease Patients
If a patient with Parkinson's disease on levodopa (L-Dopa) and Seroquel (Quetiapine) experiences syncope while seated, several factors should be considered:
- The patient's medication regimen, including the potential for orthostatic hypotension induced by levodopa therapy 2
- The presence of autonomic dysfunction, which is common in Parkinson's disease and can contribute to orthostatic hypotension 3
- The potential for postprandial hypotension, which can be exacerbated by glucose intolerance and hyperinsulinemic response 4
Treatment Options
Treatment options for orthostatic hypotension in patients with Parkinson's disease include:
- Nonpharmacological strategies, such as maintaining hydration, reducing dietary salt, and wearing high compression stockings 5
- Pharmacological agents, such as fludrocortisone, midodrine, and droxidopa, which can help to increase blood pressure and reduce symptoms of orthostatic hypotension 2, 3, 4, 5
- Reducing or discontinuing medications that may be contributing to orthostatic hypotension, such as antihypertensive medications 5
Patient Education
Patient education is an important aspect of managing orthostatic hypotension in patients with Parkinson's disease:
- Patients should be educated on the importance of maintaining hydration, avoiding sudden changes in position, and recognizing the symptoms of orthostatic hypotension 3, 5
- Patients should also be instructed on how to use nonpharmacological strategies, such as wearing high compression stockings and keeping the head of bed elevated, to help manage orthostatic hypotension 5