Midodrine 10 mg TID. Start 2.5 mg TID and increase by 2.5mg weekly until you reach 10 mg TID.
S/e: Supine HTN, paresthesia, pruritus, pilorection.
Contraindications: AKI, urinary retention, thyrotoxicosis, pheochromocytoma, severe heart disease.
MOA: Stimulates alpha-1 adrenergic receptors.
Fludrocortisone 0.1-0.2 mg PO daily. Start: 0.1mg PO QD, then increase 0.1mg/day qwk until trace pedal edema; Max: 1 mg/day. Note, doses > 0.5 mg/day are rarely more effective.
S/e: Supine HTN, Hypokalemia, Headache, CHF, edema.
Contraindications: Systemic fungal infections.
MOA: Fludrocortisone is a synthetic mineralocorticoid (like aldosterone, which is a natural mineralocorticoid). It produces multiple mineralocorticoid and glucocorticoid effects. In addition to that, it inhibits multiple inflammatory cytokines;
Other medications that work include:
- Pyridostigmine
- Erythropoietin
- Caffeine