FLUOXETINE HYDROCHLORIDE FOR THE TREATMENT OF SEVERE REFRACTORY ORTHOSTATIC HYPOTENSION

OBJECTIVE: TO evaluate the usefulness of fluoxetine hydrochloride in t he treatment of patients with severe refractory orthostatic hypotensio n. DESIGN: Prospective, nonrandomized study. PATIENTS: Five patients ( 3 men, 2 women with a mean age of 67 +/- 7 years with chronic symptoma tic orthostatic hypotension resistant to or intolerant of other therap ies. METHODS: Symptoms and orthostatic responses were recorded in the baseline state. Fluoxetine hydrochloride 20 mg orally once daily was s tarted and patients were reevaluated after 6 to 8 weeks of therapy. RE SULTS: All patients demonstrated orthostatic hypotension (20 mm Hg or greater decline in systolic blood pressure) associated with symptoms l eg, dizziness, vertigo, near syncope) in the baseline state. After 6 t o 8 weeks of fluoxetine therapy, 2 patients reported resolution of all symptoms, 2 had a marked reduction in symptoms, and 1 patient experie nced no effect. Orthostatic responses were attenuated in 4 of the 5 pa tients (80%). CONCLUSION: Fluoxetine hydrochloride may be an effective therapy for some patients with recurrent severe orthostatic hypotensi on refractory to other forms of therapy.