Efficacy of atomoxetine versus midodrine for neurogenic orthostatic hypotension
Abstract Objective The efficacy and safety of 1‐month atomoxetine and midodrine therapies were compared. Three‐month atomoxetine and combination therapies were investigated for additional benefits. Methods This prospective open‐label randomized trial included 50 patients with symptomatic neurogenic...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Annals of Clinical and Translational Neurology |
| Online Access: | https://doi.org/10.1002/acn3.50968 |
| _version_ | 1831539435505713152 |
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| author | Jung‐Ick Byun Do‐Yong Kim Jangsup Moon Hye-Rim Shin Jun‐Sang Sunwoo Woo‐Jin Lee Han‐Sang Lee Kyung‐Il Park Soon‐Tae Lee Keun‐Hwa Jung Ki‐Young Jung Manho Kim Sang Kun Lee Kon Chu |
| author_facet | Jung‐Ick Byun Do‐Yong Kim Jangsup Moon Hye-Rim Shin Jun‐Sang Sunwoo Woo‐Jin Lee Han‐Sang Lee Kyung‐Il Park Soon‐Tae Lee Keun‐Hwa Jung Ki‐Young Jung Manho Kim Sang Kun Lee Kon Chu |
| author_sort | Jung‐Ick Byun |
| collection | DOAJ |
| description | Abstract Objective The efficacy and safety of 1‐month atomoxetine and midodrine therapies were compared. Three‐month atomoxetine and combination therapies were investigated for additional benefits. Methods This prospective open‐label randomized trial included 50 patients with symptomatic neurogenic orthostatic hypotension (nOH). The patients received either atomoxetine 18 mg daily or midodrine 5 mg twice daily and were evaluated 1 and 3 months later. Those who still met the criteria for nOH at 1 month received both midodrine and atomoxetine for an additional 2 months, and if not, they continued their initial medication. The primary outcome was an improvement in orthostatic blood pressure (BP) drop (maximum BP change from supine to 3 min after standing) at 1 month. The secondary endpoints were symptom scores, percentage of patients with nOH at 1 and 3 months. Results Patients with midodrine or atomoxetine treatment showed comparative improvement in the orthostatic BP drop, and overall only 26.2% of the patients had nOH at 1 month, which was similar between the treatment groups. Only atomoxetine resulted in significant symptomatic improvements at 1 month. For those without nOH at 1 month, there was additional symptomatic improvement at 3 months with their initial medication. For those with nOH at 1 month, the combination treatment resulted in no additional improvement. Mild‐to‐moderate adverse events were reported by 11.6% of the patients. Interpretation One‐month atomoxetine treatment was effective and safe in nOH patients. Atomoxetine improved orthostatic BP changes as much as midodrine and was better in terms of ameliorating nOH symptoms. |
| first_indexed | 2024-12-16T23:41:00Z |
| format | Article |
| id | doaj.art-d196cf79c2004310a178a1f901bde489 |
| institution | Directory Open Access Journal |
| issn | 2328-9503 |
| language | English |
| last_indexed | 2024-12-16T23:41:00Z |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Clinical and Translational Neurology |
| spelling | doaj.art-d196cf79c2004310a178a1f901bde4892022-12-21T22:11:37ZengWileyAnnals of Clinical and Translational Neurology2328-95032020-01-017111212010.1002/acn3.50968Efficacy of atomoxetine versus midodrine for neurogenic orthostatic hypotensionJung‐Ick Byun0Do‐Yong Kim1Jangsup Moon2Hye-Rim Shin3Jun‐Sang Sunwoo4Woo‐Jin Lee5Han‐Sang Lee6Kyung‐Il Park7Soon‐Tae Lee8Keun‐Hwa Jung9Ki‐Young Jung10Manho Kim11Sang Kun Lee12Kon Chu13Laboratory for Neurotherapeutics Department of Neurology Comprehensive Epilepsy Center Center for Medical Innovations Biomedical Research Institute Seoul National University Hospital Seoul Republic of KoreaLaboratory for Neurotherapeutics Department of Neurology Comprehensive Epilepsy Center Center for Medical Innovations Biomedical Research Institute Seoul National University Hospital Seoul Republic of KoreaLaboratory for Neurotherapeutics Department of Neurology Comprehensive Epilepsy Center Center for Medical Innovations Biomedical Research Institute Seoul National University Hospital Seoul Republic of KoreaLaboratory for Neurotherapeutics Department of Neurology Comprehensive Epilepsy Center Center for Medical Innovations Biomedical Research Institute Seoul National University Hospital Seoul Republic of KoreaLaboratory for Neurotherapeutics Department of Neurology Comprehensive Epilepsy Center Center for Medical Innovations Biomedical Research Institute Seoul National University Hospital Seoul Republic of KoreaLaboratory for Neurotherapeutics Department of Neurology Comprehensive Epilepsy Center Center for Medical Innovations Biomedical Research Institute Seoul National University Hospital Seoul Republic of KoreaLaboratory for Neurotherapeutics Department of Neurology Comprehensive Epilepsy Center Center for Medical Innovations Biomedical Research Institute Seoul National University Hospital Seoul Republic of KoreaDepartment of Neurology Seoul National University Hospital Healthcare System Gangnam Center Seoul Republic of KoreaLaboratory for Neurotherapeutics Department of Neurology Comprehensive Epilepsy Center Center for Medical Innovations Biomedical Research Institute Seoul National University Hospital Seoul Republic of KoreaLaboratory for Neurotherapeutics Department of Neurology Comprehensive Epilepsy Center Center for Medical Innovations Biomedical Research Institute Seoul National University Hospital Seoul Republic of KoreaLaboratory for Neurotherapeutics Department of Neurology Comprehensive Epilepsy Center Center for Medical Innovations Biomedical Research Institute Seoul National University Hospital Seoul Republic of KoreaLaboratory for Neurotherapeutics Department of Neurology Comprehensive Epilepsy Center Center for Medical Innovations Biomedical Research Institute Seoul National University Hospital Seoul Republic of KoreaLaboratory for Neurotherapeutics Department of Neurology Comprehensive Epilepsy Center Center for Medical Innovations Biomedical Research Institute Seoul National University Hospital Seoul Republic of KoreaLaboratory for Neurotherapeutics Department of Neurology Comprehensive Epilepsy Center Center for Medical Innovations Biomedical Research Institute Seoul National University Hospital Seoul Republic of KoreaAbstract Objective The efficacy and safety of 1‐month atomoxetine and midodrine therapies were compared. Three‐month atomoxetine and combination therapies were investigated for additional benefits. Methods This prospective open‐label randomized trial included 50 patients with symptomatic neurogenic orthostatic hypotension (nOH). The patients received either atomoxetine 18 mg daily or midodrine 5 mg twice daily and were evaluated 1 and 3 months later. Those who still met the criteria for nOH at 1 month received both midodrine and atomoxetine for an additional 2 months, and if not, they continued their initial medication. The primary outcome was an improvement in orthostatic blood pressure (BP) drop (maximum BP change from supine to 3 min after standing) at 1 month. The secondary endpoints were symptom scores, percentage of patients with nOH at 1 and 3 months. Results Patients with midodrine or atomoxetine treatment showed comparative improvement in the orthostatic BP drop, and overall only 26.2% of the patients had nOH at 1 month, which was similar between the treatment groups. Only atomoxetine resulted in significant symptomatic improvements at 1 month. For those without nOH at 1 month, there was additional symptomatic improvement at 3 months with their initial medication. For those with nOH at 1 month, the combination treatment resulted in no additional improvement. Mild‐to‐moderate adverse events were reported by 11.6% of the patients. Interpretation One‐month atomoxetine treatment was effective and safe in nOH patients. Atomoxetine improved orthostatic BP changes as much as midodrine and was better in terms of ameliorating nOH symptoms.https://doi.org/10.1002/acn3.50968 |
| spellingShingle | Jung‐Ick Byun Do‐Yong Kim Jangsup Moon Hye-Rim Shin Jun‐Sang Sunwoo Woo‐Jin Lee Han‐Sang Lee Kyung‐Il Park Soon‐Tae Lee Keun‐Hwa Jung Ki‐Young Jung Manho Kim Sang Kun Lee Kon Chu Efficacy of atomoxetine versus midodrine for neurogenic orthostatic hypotension Annals of Clinical and Translational Neurology |
| title | Efficacy of atomoxetine versus midodrine for neurogenic orthostatic hypotension |
| title_full | Efficacy of atomoxetine versus midodrine for neurogenic orthostatic hypotension |
| title_fullStr | Efficacy of atomoxetine versus midodrine for neurogenic orthostatic hypotension |
| title_full_unstemmed | Efficacy of atomoxetine versus midodrine for neurogenic orthostatic hypotension |
| title_short | Efficacy of atomoxetine versus midodrine for neurogenic orthostatic hypotension |
| title_sort | efficacy of atomoxetine versus midodrine for neurogenic orthostatic hypotension |
| url | https://doi.org/10.1002/acn3.50968 |
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