Octreotide orthostatic hypotension

In a controlled study of octreotide and midodrine (an alpha-adrenoceptor agonist) in patients with orthostatic hypotension, the pressor effect of the two drugs was synergistic (56). 

Hoeldtke RD, Horvath GG, Bryner KD, Hobbs GR. Treatment of orthostatic hypotension with midodrine and octreotide. J Clin Endocrinol Metab 1998 83(2) 339-43. 

The major therapeutic use of SST is to block hormone release in endocrine-secreting tumors, Available SST analogs and their clinical uses are described in Chapter 55. Since the analog octreotide also can decrease blood flow to the GI tract, it has been used to treat bleeding esophageal varices, peptic ulcers, and postprandial orthostatic hypotension. 

A. Orthostatic hypotension. The most important is to limit use of vasoactive substances. If non-pharmacologic measures are not mough then fludrocortisone should be tried starting with a dose of 0.1 mg at bedtime and increased to 0.4 mg/day [38], Side effects are oedema and recumbent hypertension. Other compounds that have been tested with positive results include Erythropoietin, Octreotide, desmopressin and midodrine. 

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