Ambulatory norepinephrine treatment of severe autonomic orthostatic hypotension

• Published in: Journal of the American College of Cardiology 2001-01, Vol.37 (1), p.219-223
• Main Authors: Oldenburg, Olaf, Mitchell, Anna, Nürnberger, Jens, Koeppen, Susanne, Erbel, Raimund, Philipp, Thomas, Kribben, Andreas
• Format: Article
• Language: English
• Subjects: Aged; Ambulatory Care; Autonomic Nervous System Diseases - drug therapy; Biological and medical sciences; Cardiovascular system; Female; Humans; Hypotension, Orthostatic - drug therapy; Infusion Pumps, Implantable; Male; Medical sciences; Middle Aged; Miscellaneous; Norepinephrine - administration & dosage; Pharmacology. Drug treatments; Treatment Outcome
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(00)01062-7

OBJECTIVES This study was designed to establish a patient-controlled, ambulatory norepinephrine treatment of refractory orthostatic hypotension due to primary autonomic failure. BACKGROUND Autonomic dysfunction leads to disabling postural hypotension. Particularly in primary autonomic dysfunction, repeated syncope and immobilization can be the result. Medical treatment of orthostatic hypotension often fails in advanced cases. METHODS Ambulatory, patient-controlled norepinephrine therapy was initiated in six patients with orthostatic hypotension due to primary autonomic failure that had been refractory to conventional treatment. Before this therapy, three patients were bedridden; one was immobilized in a wheelchair. All had recurrent syncope and tolerated upright tilt-table testing for less than 15 min despite extensive medical treatment. For ambulatory treatment, a port-a-cath system was implanted and, using a CADD ambulatory infusion pump, norepinephrine was infused in individually adjusted dosages. RESULTS Norepinephrine infusion therapy enabled all patients to sit, stay and walk around for more than 45 min. One patient died after a five-year treatment period, another after nine months because of nonhemorrhagic brain stem infarctions, both in the absence of norepinephrine treatment. The remaining four patients are still mobile after a period of 19, 10, 9 and 7 months, respectively. None of them has suffered complications due to arterial hypo- or hypertension, and there has been no infection of the infusion system. CONCLUSIONS In these selected patients with refractory orthostatic hypotension due to primary autonomic dysfunction, ambulatory norepinephrine infusion therapy has proved to be a promising new therapeutic option. Further long-term studies including more patients are necessary to assess additional indications, reliability and safety of this new method.