Treatment of Parkinson's Disease in Orthostatic Hypotension

Clinical scenario

This protocol addresses patients with Parkinson's disease who also present with orthostatic hypotension — a common and functionally significant autonomic complication in this population.

Diagnosis of orthostatic hypotension

A Schellong test should be performed to diagnose orthostatic hypotension in patients with Parkinson's disease. Identifying and confirming this comorbidity is an essential step before selecting a management approach.

Treatment approach (partial overview)

Pharmacological therapy is the cornerstone of managing orthostatic hypotension in this setting. The protocol specifies which agents are recommended, which can be considered, and under what conditions — including off-label options. Full sequencing, agent selection criteria, and supporting evidence are in the complete regimen.

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References

DOI: 10.1186/s42466-024-00325-4

A Schellong test should be performed to diagnose orthostatic hypotension in PD patients.

As pharmacological measures for the treatment of orthostatic hypotension in PD patients, a therapy with midodrine should be recommended, treatment with fludrocortisone can be recommended, treatment with droxidopa (L-Threo-DOPS) may be considered (off-label use, only available from international pharmacies).

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