Orthostatic Intolerance - Management and Prognosis

Management and Prognosis

Most patients experience an improvement of their symptoms, but for some, OI can be gravely disabling and can be progressive in nature, particularly if it is caused by an underlying condition which is deteriorating. The ways in which symptoms present themselves vary greatly from patient to patient; as a result, individualized treatment plans are necessary.

OI is treated both pharmacologically and non-pharmacologically. Treatment does not cure OI; rather, it controls symptoms.

Physicians who specialize in treating OI agree that the single most important treatment is drinking more than two liters (eight cups) of fluids each day. A steady, large supply of water or other fluids reduces most, and for some patients all, of the major symptoms of this condition. Typically, patients fare best when they drink a glass of water no less frequently than every two hours during the day, instead of drinking a large quantity of water at a single point in the day.

For most severe cases and some milder cases, a combination of medications are used. Individual responses to different medications vary widely, and a drug which dramatically improves one patient's symptoms may make another patient's symptoms much worse. Medications focus on three main issues:

Medications that increase blood volume:

• Fludrocortisone (Florinef)
• Erythropoietin
• Hormonal contraception

Medications that inhibit acetylcholinesterase:

• Pyridostigmine

Medications that improve vasoconstriction:

• Stimulants: (e.g., Ritalin or Dexedrine)
• Midodrine (Proamatine)
• Ephedrine and pseudoephedrine (Sudafed)
• Theophylline (low-dose)
• Selective serotonin reuptake inhibitors (Prozac, Zoloft, and Paxil)

Behavioral changes that patients with OI can make are:

• avoiding triggers such as prolonged sitting, quiet standing, warm environments, or vasodilating medications
• using postural maneuvers and pressure garments
• treating co-existing medical conditions
• increasing salt and fluid intake
• physical therapy and exercise