PMC:6723065 / 40161-41317 JSONTXT

{"project":"2_test","denotations":[{"id":"31434341-26474316-7278361","span":{"begin":286,"end":287},"obj":"26474316"},{"id":"31434341-28674867-7278362","span":{"begin":490,"end":493},"obj":"28674867"},{"id":"31434341-25489118-7278363","span":{"begin":643,"end":646},"obj":"25489118"},{"id":"31434341-30637284-7278364","span":{"begin":752,"end":755},"obj":"30637284"},{"id":"31434341-25350981-7278365","span":{"begin":756,"end":759},"obj":"25350981"}],"text":"Dysautonomic symptoms (DS) occurring in advanced PD include orthostatic hypotension (OH) and urinary dysfunction (UD). Both symptoms, according to current criteria, should not be clinically relevant within the first five years of disease; otherwise, MSA diagnosis should be considered [3]. OH is a major risk factor for falls in PD patients and should be carefully evaluated. Droxidopa 100–300 mg tid, can improve lightheadedness and orthostatic dizziness as monotherapy or add-on therapy [149]. Other possible pharmacological treatments are Fludrocortisone 0.1–0.2 mg daily or (in some countries) Midodrine 10 mg tid (second-line treatment) [150]. No particular safety issues have been reported for Droxidopa, except for cardiovascular comorbidities [151,152]. However, Fludrocortisone could lead to hypokalemia and should not be administered in patients with heart or renal failure. Midodrine may cause or worsen urinary retention, instead, which is also common in advanced PD. Moreover, some degree of supine hypertension can occur with all of these drugs (less frequently with Droxidopa). Laying with a raised head could help reducing this side effect."}