How do I manage postural (orthostatic) hypotension in people with Parkinsons disease?
• Consider a stepped approach to the management of postural (orthostatic) hypotension in Parkinson’s disease: • Stop or reduce the dose of antihypertensive medications. • Reduce or change anti-parkinsonian drugs after discussion with specialist services. • Advise the person to increase their dietary salt and fluid intake, to avoid caffeine at night, to eat frequent, small meals, and to avoid alcohol. • Advise the person to elevate the head of their bed by 30–40 degrees. • Consider prescribing compression stockings after excluding arterial insufficiency (see the CKS topic on Compression stockings). • Consider referring people with persistent or troublesome symptoms to a unit with expertise in falls and syncope. • A salt-retaining steroid (such as fludrocortisone) may be recommended. • Occasionally, midodrine (a direct-acting sympathomimetic) may be prescribed, but this is only available on a named-patient basis.
