From the Guidelines
Medications such as midodrine, droxidopa, and fludrocortisone can be used for the prevention of syncope due to neurogenic orthostatic hypotension, as recommended by the 2017 ACC/AHA/HRS guideline 1. The choice of medication depends on the underlying cause of syncope, with different medications targeting different mechanisms.
- Midodrine works by constricting blood vessels to maintain blood pressure, and is recommended for patients with neurogenic OH 1.
- Droxidopa improves symptoms of neurogenic OH by increasing norepinephrine levels, and is also recommended for patients with neurogenic OH 1.
- Fludrocortisone increases plasma volume, resulting in improved symptoms of OH, and may be beneficial in patients with neurogenic OH 1. Other medications, such as pyridostigmine and octreotide, may be beneficial in patients with syncope due to neurogenic OH who are refractory to other treatments 1. Non-pharmacological measures, such as increased salt and fluid intake, compression stockings, and physical counter-pressure maneuvers, can also be beneficial in preventing syncope 1. It is essential to have a proper diagnosis of the syncope type, as treatment approaches differ significantly, and to consider the potential side effects and limitations of each medication, such as supine hypertension and urinary retention 1.
From the Research
Medications for Prevention of Syncope
The following medications can be used for the prevention of syncope:
- Fludrocortisone 2, 3, 4
- Midodrine 2, 3, 4
- Erythropoietin 2
- Selective serotonin reuptake inhibitors 3
- Beta-blockers 4
Non-Pharmacological Measures
In addition to medications, non-pharmacological measures such as:
- Increased salt and water intake 2, 3, 4
- Physical counter-pressure manoeuvres 5, 4
- Patient education 2, 3 can also be effective in preventing syncope.
Treatment of Underlying Conditions
Treatment of underlying conditions such as orthostatic hypotension, hypovolemia, and primary or secondary autonomic disorders is also crucial in preventing syncope 5, 2, 3, 6.