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Treatment of Orthostatic Hypotension with Octreotide^*

Department of Medicine, Division of Endocrinology/Metabolism, Temple University School of Medicine Philadelphia, Pennsylvania 19140
The General Clinical Research Center, Temple University School of Medicine Philadelphia, Pennsylvania 19140

Address all correspondence and requests for reprints to: Robert D. Hoeldtke, M.D., Ph.D., Department of Medicine, Temple University Health Sciences Center, 3401 North Broad Street, Philadelphia, Pennsylvania 19140.

The purpose of this study was to evaluate the therapeutic potential of the somatostatin analog octreotide in patients with orthostatic hypotension. Octreotide was administered sc, and its pressor effect was assessed while the patients were semirecumbent and on the tilt table. We also studied the effect of octreotide on blood pressure while patients walked. The efficacy of therapy was assessed by measuring the duration of walking (walking time) before the onset of hypotension.

Low doses of octreotide (0.2–0.4 µg/kg) had a pressor effect in all patients with progressive autonomic failure (n = 7), multiple system atrophy (n = 7), and diabetic autonomic neuropathy (n = 8), but not in patients with sympathotonic orthostatic hypotension (n = 6). Larger doses (0.4–1.6 µg/kg) resulted in a sustained (50 min) increase in blood pressure during walking in four of six patients with progressive autonomic failure and in one of six patients with multiple system atrophy. Some patients in whom octreotide failed to stabilize upright blood pressure had a satisfactory response to the drug after pretreatment with dihydroergotamine (10 µg/kg, sc). Patients with diabetic autonomic neuropathy, although sensitive to the pressor effect of octreotide, often developed nausea or abdominal cramps after moderate doses (>1.0 µg/kg).

These results indicate that the pressor effect of octreotide is sufficiently potent to prevent orthostatic hypotension in some patients with autonomic neuropathy. Others require treatment with both dihydroergotamine and octreotide to achieve a stable upright blood pressure.

^* This work was supported by USPHS Grants AG-06481, AM-32239, and RR-00394 to the General clinical Research Center.

Received November 11, 1988.

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