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Dr. D. Love
Dr. D. Love, Doctor
Category: Neurology
Satisfied Customers: 18764
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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My 68 year old husband has been experiencing severe

Customer Question

My 68 year old husband has been experiencing severe orthostatic hypotension since suffering a stroke in June 2015. His blood pressure has frequently gotten so low that it doesn't even register and he's then at the point of passing out. This has dramatically affected his ability to walk and participate in physical therapy activities. He is now confined to a wheel chair and mobility is limited. He has been prescribed midorine and fludrocortisone to treat this condition, but with very limited success. He has been seen by numerous physicians (neurologists, heart specialists, and GPs), but no one seems to know what to do with him. Meanwhile, his condition and physical abilities continue to decline. Is there anything else that can be done? Are there additional treatments that you would recommend? If his records were sent to you, could we get a second opinion?
Additional currently prescribed meds are: Cymbalta, Keppra, Senna, Xopenex, Calmoseptine, amiodarone, gabapentin, aspirin, and Ted hose
Submitted: 2 years ago.
Category: Neurology
Expert:  Dr. D. Love replied 2 years ago.

Hello from JustAnswer.

It will help if you could first provide some further information.

What lifestyle interventions have been implemented?

Has there been any attempt to try to try alternative medicines for the other medical conditions, particularly the medicines that may be worsening the problem?

Expert:  Dr. D. Love replied 2 years ago.

I had asked for some further information and have not heard back.

When dealing with severe orthostatic hypotension that is not responding to midodrine or flucrocortisone, there are several options to consider and I asked the above questions to ascertain whether these other options have been tried.

It is important to consider any other medicines that may be making the orthostatic hypotension worse. Even in people in whom the primary reason for the orthostatic hypotension is a neurologic condition, these medicines may be making it worse. Of course, each of these medicines were started for a medical condition that will typically still need treatment, so it is usually not as simple as just stopping any drug that may be contributing to the problem. Of the medicines that he is taking, the amiodarone and the gabapentin are the medicines that are most likely to be contributing to orthostatic hypotension, but the Cymbalta and Keppra also could be a factor.

It also may help to implement certain lifestyle changes. You mention that he has been trying TED hose, but there are several other interventions that can be tried. He has likely been told to increase the intake of salt and water. It may help to augment the TED hose with an abdominal binder. It may help to place 4-6 inch blocks under the feet at the head of the bed, so that he sleeps at an angle, and this is more effective than simply sleeping on more pillows.

As for medicines, the midodrine and fludrocortisone are the common medicines that are used for this. There are a couple of other medicines that can be considered, including pyridostigmine or droxidopa, although it is more common to try the above interventions before trying one of these medicines.

If I can provide any further information, please let me know.