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Drug-induced orthostatic hypotension (OH) is common, and its resulting cerebral hypoperfusion is linked to adverse outcomes including falls, strokes, cognitive impairment, and increased mortality. The extent to which specific medications are associated with OH remains unclear. High risk of orthostatic hypotension. Alternative recommended agents have superior risk-benefit profile ALL Centrally-Acting Medications High risk of adverse CNS effects, bradycardia, and orthostatic hypotension Immediate Release Nifedipine Potential for hypotension Antihypertensives1,2,9-16 UNC Eshelman School of Pharmacy | July 2018 5 Orthostatic hypotension is reported as a side effect among people who take Gabapentin (gabapentin), especially for people who are male, 60+ old, have been taking the drug for < 1 month also take Aspirin, and have High blood pressure. Several cardiovascular and psychoactive medications may alter the blood pressure response to standing, leading to drug-related orthostatic hypotension. This narrative review provides an overview on cardiovascular and non-cardiovascular medications potentially impairing orthostatic blood pressure. Perioperative gabapentin administra-tion has been associated with greater incidence of dizzi-ness, visual disturbances, and increased risk for postop-erative pulmonary complications. We present a 13-year-old female who experienced intraoperative hypotension which was eventually attributed to the preoperative ad-ministration of gabapentin. Orthostatic hypotension (OH) is common, affecting up to 30% of the general population over 65 and up to 70% of people living in nursing homes. It is defined by a drop in the systolic blood pressure (BP) of 20 mmgh or/and diastolic BP of 10 within 3 min of standing. Neurogenic orthostatic hypotension is a type of OH caused by autonomic failure and multiple system atrophy. It is relatively Drug-induced orthostatic hypotension is an important clinical problem. When symptomatic, it is poorly tolerated by the patient, and can be a cause for discontinuing treatment. It may have more serious consequences if it leads to syncope, falls and injury, or to sustained loss of perfusion of vital o While asking for a question that obesity can also cause orthostatic hypotension, the answer is yes. Orthostatic hypotension occurs in overweight patients by the following mechanism. When an obese patient is lying down, there is increased pressure on the inferior vena cava due to the weight of subcutaneous fat on the abdomen. Measuring heart rate with each position change can help detect baroreflex dysfunction. 2, 22, 24, 27 The compensatory rise in heart rate is maintained in nonneurogenic orthostatic hypotension Several medications can cause low blood pressure (hypotension). Examples include phosphodiesterase 5 (PDE5) inhibitors, nitrates, and blood pressure medications. Opioids, antipsychotics, and certain antidepressants can also cause low blood pressure. Chronic orthostatic hypotension (OH) is a common, often underdiagnosed, disorder, defined by an excessive fall in blood pressure (BP) with standing. OH can be associated with postural lightheadedness, dizziness, fatigue, coat hanger pain, and, in extreme situations, syncope, falls, and injuries. Orthostatic hypotension is common with an overall prevalence of up to 20 percent. Many disorders can cause orthostatic hypotension, as can acute or chronic volume depletion and a side effect of medications (particularly antihypertensive agents). The depressor effect of gabapentin in the NTS recovered gradually over 90 min after L-NAME treatment (-8 ± 2 versus -20 ± 3 mmHg and -13 ± 3 versus -36 ± 8 bpm; Figure 2B). These results indicated that gabapentin may have induced NOS to induce hypotension and bradycardia in the NTS of the SHR rats. Figure 2. Data on chronic opioid treatment are limited, but hypotension, orthostatic hypotension, and syncope are commonly reported among potential adverse effects of most opioid analgesics, such as morphine, buprenorphine, fentanyl, oxycodone, and tapentadol [55•]. Yet, the mechanism underlying opioid-mediated hypotension still remains a matter of debate. Gabapentin side effects are usually mild, and they may be less common with gabapentin ER forms. Examples of mild side effects that can happen include: Though rare, serious gabapentin side effects can also happen. Examples include: Gabapentin drug interactions: Along with side effects, gabapentin has possible interactions to know about. This review focuses on the prevention and treatment of neurogenic causes of orthostatic hypotension. We emphasize a simple but effective patient-oriented approach to management, using a combination of nonpharmacologic strategies and drugs clinically proven to be efficacious. Figure. Spectrum of orthostatic hypotension (OH). Clinical development of OH requires the presence of autonomic impairment (due to aging, diabetes, and primary autonomic neuropathies) often in combination with aggravating factors that overwhelm or impair compensatory autonomic responses (volume depletion, infections, deconditioning, and medications). carry cumulative risk, suggesting that individuals with polypharmacy could benefit from pos-tural BP monitoring. Author summary Why was this study done? • Orthostatic hypotension (OH) is a common side effect of drugs. It causes a reduction in blood pressure (BP) on standing, which results in reduced cerebral blood flow that is Orthostatic hypotension is a frequent cause of falls and syncope, impairing quality of life. It is an independent risk factor of mortality and a common cause of hospitalizations, which exponentially increases in the geriatric population. We present a management plan based on a systematic literature review and understanding of the underlying pathophysiology and relevant clinical pharmacology Syncope is a frequent cause of emergency department visits 22 and about half of these result in hospital admission. 23 About 24%-31% of patients presenting with syncope in the emergency setting have orthostatic hypotension. 24, 25 Orthostatic hypotension should be considered in the differential diagnosis of patients hospitalized for syncope
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